Women's Golf Support Staff and Officials COVID-19 Screening Questionnaire

Email Secondary Email

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Are you support staff or official? *

Support Staff Official

First Name *

Last Initial *

Phone Number *

Email address *

Have you been in close contact unmasked with someone who has been diagnosed with Coronavirus within the last 14 days? (Close contact is < 6 feet for ?15 minutes) *If participant has tested positive for COVID-19 within the past 90 days, this exposure item is rendered moot. *

Yes No

Do you currently have a temperature of 100.4 or greater? *

Yes No

Do you have repeated shaking or chills? *

Yes No

Do you have a new loss of smell and/or taste? *

Yes No

Do you have shortness of breath that is not associated with a preexisting condition (i.e asthma)? *

Yes No

Do you have a cough (new or different than normal)? *

Yes No

Do you have muscle or body aches? *

Yes No

Do you have diarrhea/upset stomach/nausea? *

Yes No

Do you have a sore throat? *

Yes No

Do you have a headache? *

Yes No

Do you have congestion that is not associated with a preexisting condition (i.e allergies)? *

Yes No

* required field