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Ike Daily Health Log
Ike Football Daily Health Log
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Last Name
*
Your answer
First Name
*
Your answer
Today’s Date
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MM
/
DD
/
YYYY
Phone Number
*
Your answer
Have you had a new or unusual cough in the last 24 hours?
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Yes
No
Have you had a fever of 100.3 or higher in the last 24 hours?
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Yes
No
Have you been experiencing any loss of taste or smell?
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Yes
No
Have you had a sore throat in the last 24 hours?
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Yes
No
Have you had diarrhea in the last 24 hours?
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Yes
No
Have you had shortness of breath in the last 24 hours?
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Yes
No
Have you had any flu like symptoms (body aches, chills, extreme fatigue)
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Yes
No
Have you had close contact or cared for someone with a confirmed case of COVID-19 in the last 14 days and without a mask?
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Yes
No
You will be required to bring your own water and have enough for yourself for the duration of your workout. Will you be bringing enough water/gatorade/powerade to stay hydrated?
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Yes
No
You will not be allowed to share liquids, food or equipment. Do you agree to this.
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Yes
No
Mask will be required for entering and exiting facilities as well as during non high intensity cardio workouts. Please make sure you bring and wear a mask. Do you acknowledge?
*
Yes
No
Current temperature. (This will be taken by a coach when you arrive)
*
Your answer
Emergency Contact Name
*
Your answer
Emergency Contact Number
*
Your answer
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