Gallaudet Athletics Spectators Health Self-Assessment Form

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Which Gallaudet sporting event are you attending today? *

Football

Men's Soccer

Women's Soccer

Women's Volleyball

Swimming and Diving

Men's Basketball

Women's Basketball

Baseball

Softball

Track & Field

Required

Your Name *

What state do you reside in? *

What is your e-mail address? *

What is your cell/text number? *

Do you have a fever or feel like you have a fever? *

Yes

Have you recently experience a loss of taste or smell? *

Yes

Are you experiencing any shortness of breath? *

Yes

Are you experiencing any muscle aches? *

Yes

Are you experiencing any chills? *

Yes

Are you experiencing cough? *

Yes

Are you experiencing a sore throat? *

Yes

Are you experiencing an unexplained headache? *

Yes

Have you experienced any gastrointestinal symptoms such as nausea, vomiting, diarrhea or loss of appetite? *

Yes

Have you, or anyone you have been in close contact with, been diagnosed with COVID-19 or have been placed on quarantine for possible contact with COVID-19, within the last 14 days? *

Yes

Have you been asked to self-isolate or quarantine by a medical professional or a local public health official, within the last 14 days? *

Yes

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