Daily Health Assessment for OPP Fall Swim 2020
In order to ensure the continued health and safety of our staff and swimmers, please fill out and submit the following Health Assessment Form each day of the program.   Swimmers and staff will not be allowed on the pool grounds without a completed form or if the answer to any question is "Yes".

Please submit one form for EACH participant, before arriving to the pool, EVERY DAY they attend.  

If you answer YES to any of the following questions, please DO NOT come to the pool and immediately NOTIFY the program head coaches at bradtheflyman@yahoo.com and qcavalli@gmail.com
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Email *
Participant LAST Name *
Participant FIRST Name *
Name of person submitting (first and last name) *
Questions
Has participant come in contact with someone who has COVID-19 or symptoms of Covid-19 in the past 14 days? *
In the past 48 hours, has the participant shown any symptoms of COVID-19? *
Symptoms include, but are not limited to: Cough; Trouble breathing; Shortness of breath or severe wheezing; Chills or repeated shaking with chills; Muscle aches; Sore throat, Loss of smell or taste, or a change in taste; Nausea, vomiting or diarrhea; Headache
Please take participant's temperature.  Is temperature over 100F (38C)? *
If you answered YES to any of these questions, please DO NOT come to the pool and immediately NOTIFY the program head coaches at bradtheflyman@yahoo.com and qcavalli@gmail.com. A copy of your responses will be sent to you at the email address you provided.

By clicking submit, you attest that all of your answers are true, to the best of your knowledge, and that you are the legal guardian or authorized agent of the named participant.
A copy of your responses will be emailed to the address you provided.
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