GATORS COVID - 19 questionnaire

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This questionnaire must be completed for all players every session/each day before they will be allowed on the ice. Complete this COVID-19 health questionnaire prior to practice/game. If player is experiencing COVID-19 related symptoms contact your program coordinator. Please say home to protect others.
Please contact your program coordinator if you have any COVID-19 related questions.

Players name *

Date of practice/ game *

YYYY

Email *

Do you have any of the following COVID-19 Symptoms? (Where you can not attribute the symptom to another health condition.) * *

A fever? (Temperature greater than 100.4 degrees F)

A new or worsening cough?

Shortness of breath/ difficulty breathing?

Runny nose and/or congestion?

Body aches and/or tiredness?

Vomiting and/or diarrhea?

New loss of smell or taste?

I have experienced NONE of these

Other:

If the answer to any of the questions above is "YES", stay home and consult your primary care physician. If a doctor determines that the symptoms are due to another diagnosis, or COVID- 19 is ruled out, you may return to activity after being fever-free for 24 hours without the use of fever-reducing medications *

Have you had close contact with anyone who had a positive COVID - 19 diagnostic test in the past 14 days?

Have you traveled out of the US in the last 14 days?

I have experienced NEITHER of these

Other:

Required

If the answer is "YES" to either of these questions,

You must stay home to quarantine for 14 days since last contact or return to the US

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