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Spectator Covid Screening Questionnaire
In accordance with IDPH guidelines, please fill out the screening prior to entering the gym facility
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* Indicates required question
Email
*
Your email
Name (Last, First)
*
Your answer
Today's Date
*
MM
/
DD
/
YYYY
Level of Football
*
Varsity
F/S
Temperature over 99.0 F
*
Yes
No
Option 3
Contact information (Phone)
*
Your answer
Do you currently have a fever, cough, chills and or muscle aches?
*
Yes
No
Other:
Do you currently have a sore throat, runny nose, and or loss of taste or smell?
*
Yes
No
Do you currently have nausea, vomiting and or diarrhea?
*
Yes
No
Do you currently have shortness of breath and or headache?
*
Yes
No
Have you been in close contact, or cared for someone with Covid 19 in the last 14 days?
*
Yes
No
Any additional information you need to add
Your answer
A copy of your responses will be emailed to the address you provided.
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