Mercy Athletics Visitors' COVID-19 Screening: Complete on DAY OF EVENT

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ALL visitors to Mercy must complete this questionnaire ON THE DAY OF THE EVENT.

If you have one or more symptom(s) or risk factors that may be related to COVID-19, STAY HOME and take care of yourself.

The information collected on this form will be maintained as confidential and is used to determine whether you may be infected with COVID-19 and should not attend Mercy Athletic activities.

We appreciate your help in keeping everyone safe.

Email *

First Name *

Last Name *

Phone #: MUST include *

Reason for visiting Mercy today (form MUST be completed on DAY OF EVENT): *

LAX

Soccer

Softball

Tennis

Track & Field

Team *

Mercy

Visitor

Level *

Varsity

Track & Field

Athlete Name *

Are you or anyone in your household awaiting the results of a COVID test? *

Yes

Have you developed a new or unusual cough, sore throat, shortness of breath, &/or difficulty breathing in the last 24 hours? *

Yes

Have you developed nausea, vomiting, &/or diarrhea in the past 24 hours? *

Yes

Are you experiencing loss of taste or smell? *

Yes

Have you had a fever over 100.3, drenching night sweats, &/or night chills in the last 24 hours? *

Yes

Have you had close contact (15 minutes or more in a 24 hour period) with or cared for someone with a confirmed case of COVID-19 in the last 14 days? *

Yes

Have you developed muscle aches, headaches, or fatigue in the last 24 hours? *

Yes

Send me a copy of my responses.

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