Pond Hockey LLC / Lawmen Hockey - Daily COVID-19 Symptom Screening Tool

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This tool will be used to screen for symptoms of COVID-19 for all persons planning to enter Twin Ponds, at 3904 Corey Road, Harrisburg, PA 17109.

This screening tool should be filled out DAILY by every skater, parent/guardian, or coach that is planning to enter the building until further notice.

This tool will allow for tracing activities should there be a future exposure to COVID-19.

Thank you!

Email *

Names of ALL persons that will enter Twin Ponds today from your family: *

Phone number to reach you: *

Have you or anyone living in your household traveled outside the USA within the last 14 days? *

Yes

Have you and/or anyone living in your home had any of the following symptoms since your last time at Twin Ponds that you cannot attribute to another health condition? Check all that apply. (*Note: Symptoms may change in the tool to reflect current CDC guidelines.) *

Fever (temperature > 99.5°F or > 37.5°C)

Chills

A New Cough

Shortness of Breath or Chest Pain

Sinus or cold-like symptoms (headache, congestion/runny nose, sore throat)

New Muscle Aches (not exercise related)

New Loss of Smell or Taste

Gastrointestinal symptoms (nausea, vomiting and/or diarrhea)

Myself and my family members in our household have had NONE of the above symptoms, and I understand that if I checked any of the above symptoms my family will NOT be allowed to enter Twin Ponds today.

Required

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