STLWest Association COVID-19 Team Report

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

This form will be used daily in lieu of symptom checking upon your arrival to any STLWest Ballpark. This information will only be used in the event we need to contact you due to COVID-19 exposure.

COVID SCREENING QUESTIONS

1) Has anyone on your team (players or coaches) experienced any of the following symptoms in the past 48 hours: • fever or chills • cough • shortness of breath or difficulty breathing • fatigue • muscle or body aches • headache • new loss of taste or smell • sore throat • congestion or runny nose • nausea or vomiting • diarrhea

2.) Within the past 14 days, have you been in close physical contact (6 feet or closer for a cumulative total of 15 minutes) with: • Anyone who is known to have laboratory-confirmed COVID-19? OR • Anyone who has any symptoms consistent with COVID-19?

3.) Are you isolating or quarantining because you may have been exposed to a person with COVID-19 or are worried that you may be sick with COVID-19?

4.) Are you or anyone in your household, currently waiting on the results of a COVID-19 test?

Did any member of your team answer "YES" to any of the COVID-19 screening questions above? *

Yes

Park where your game is being played *

Field on which your game is being played? *

Coach's First and Last Name *

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms