Dakota Track & Field COVID-19 Monitoring Form
Please complete the following heath screening questions daily before attending a conditioning/practice workout.  If you have not been feeling well please stay home for the day, rest and recover.  (Please complete by 2:30 pm)
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Email Address *
First Name *
Last Name *
Team *
Event Group *
Emergency Contact Name *
Emergency Contact Phone Number *
Use this format (586) 555-5309
Have you had a known exposure to COVID-19?  A known exposure is defined as unmasked, close contact (less than 6 feet) for greater than 15 minutes with an individual with a confirmed case of COVID-19 or suspected case awaiting test results. An exposure can also be defined as someone in your household who has tested positive for COVID-19 in the last 14 days or is awaiting COVID-19 results due to symptoms. *
Do you have any NEW loss of taste or smell? *
Have you had a sore throat or new or unusual cough in the last 24 hours? *
Do you have any Covid-19 symptoms?   Shortness of breath not typical for you?  Diarrhea more frequent than usual? *
Have you had any flu like symptoms (body aches, chills, extreme fatigue) or Fever of 100.3 degrees or higher in the last 24 hours? *
Water can not be provided at this time, during  conditioning or practice.  Will you bring enough water/Gatorade/Powerade to stay hydrated for the entire workout. *
Do you acknowledge that masks will be required for entering and exiting facilities. Also, during indoor workouts and non high intensity workouts, outdoors. Will you bring your own Personal Protection Equipment (PPE)? *
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