COVID-19 daily screening

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Please answer all questions honestly in order to best insure the safety of our community.

Full name *

I am coming to the pool today for: *

Have you had a temperature greater than 100.4F in the past 72 hours? *

Yes

Within the past 10 days have you been diagnosed with COVID-19, had a test confirming you have the virus, or been advised to self-isolate or quarantine by your doctor or a public health official? *

Yes

Have you had any one or more of the following symptoms today or within the past 24 hours, which is not new or not explained by another reason: Fever, chills, cough, shortness of breath, sore throat, fatigue, headache, muscle/body aches, runny nose/congestion, new loss of taste or smell, or nausea, vomiting, or diarrhea? *

Yes

Close contact is defined as a) Someone who was within 6 feet of an infected person for a cumulative total of 15 minutes or more over a 24-hour period starting from 2 days before illness onset or, (for asymptomatic patients, 2 days prior to testing specimen collection) until the time the patient is isolated. OR b) Direct contact with infectious secretions from a patient with COVID-19. Infectious secretions may include sputum, serum, blood, and respiratory droplets (e.g., being coughed or sneezed on).

In the past 14 days, have you had close contact, as defined above, with an individual diagnosed with COVID-19? *

Yes

In the past 14 days have you traveled internationally? *

Yes

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