Pre-training Covid-19 Health Screening Declaration.

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To be completed at least three hours prior to every training session for every swimmer participating. If this form is not returned the swimmer will not be allowed to participate in that training session.

Email *

Swimmer’s full name: *

Group *

Prem

Lengths 2

Lengths 1

Widths 4

Widths 3

Widths 2

Widths 1a

Seniors

Is anyone else in your household, or anyone who takes you to and from training or who attends training with you currently showing symptoms of Covid-19 or has experienced symptoms in the last 10 days? *

Yes

Are you currently showing or have you experienced any of the following symptoms of Covid-19 in the last 10 days (a high temperature, a new continuous cough and/or a loss or change to your sense of smell or taste?) *

Yes

Have you or anyone else in your household, or anyone who takes you to and from training or who attends training with you had a positive test for Covid-19 in the last 10 days? *

Yes

Has the swimmer named on this form been told to self isolate? (If a swimmer is in isolation they must not attend swimming until their period of isolation is over and they have returned to school/college/work etc) *

Yes

Please read the paragraph below and tick yes to confirm that you have understood it and accepted responsibility for ensuring that you are fit to participate in training sessions. *

I confirm that the swimmer named on this form is only attending training today in the full knowledge that they are free from any Covid-19 symptoms. In addition, I confirm that if they do display any symptoms they will not attend training for a period of at least 10 days and will follow the current government guidance with regard to self-isolation. They return to training knowing that their participation cannot be without risk, I am therefore aware of the risks associated with the Covid-19 virus, but still wish them to participate in club training. I understand the processes and protocols Stourbridge Swimming club have put in place in order to reduce risks and I will adhere to these in order to protect my health and the health of other members, staff and other users of the facility.

Yes

Send me a copy of my responses.

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