Health Manager COVID-19 Reporting Form
Complete one form for each individual that has reported: 1) A positive COVID-19 test result, or 2) A close contact exposure to a person with confirmed COVID-19 outside of RAYHA activities.  DO NOT submit forms for each player on the team based upon a report of a player or coach testing positive COVID-19.  Potential team exposure will be determined by the COVID-19 Task Force based upon the answers to these questions and contact tracing efforts.  Final determinations will be reported back to the affected individuals, the Health Manager, and the Head Coach.
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Email *
Team Health Manager First Name *
Team Health Manager Last Name *
Type of Incident *
Team *
First Name of Affected Individual *
Last Name of Affected Individual *
Parent/Guardian First Name (n/a for coaches) *
Parent Guardian Last Name (n/a for coaches) *
Contact Phone Number *
Date of Positive Test - MM/DD/YYYY - (Type N/A if not applicable)   *
Date of Symptoms Onset - MM/DD/YYYY - (Type N/A if not applicable) *
Date of Exposure - MM/DD/YYYY - (Type N/A if not applicable or unknown) *
POSITIVE COVID-19 TEST ONLY: Date(s) and Types of Activities (Practices or Games) Attended by the Affected Individual in the 48 Hours Before the Onset of Symptoms - MM/DD/YYYY and Type of Activity - (Type N/A if an exposure incident) *
POSITIVE COVID-19 TEST ONLY:  RAYHA Teams and Teams Outside of RAYHA Potentially Affected (Type N/A if not applicable) *
POSITIVE COVID-19 TEST INDIVIDUAL or  HOUSEHOLD MEMBER POSITIVE COVID-19 TEST EXPOSURE ONLY: Household Members Also Affected (Provide the Team/Level Where They Play/Coach (RAYHA Members Only) (Type N/A if not applicable or unknown) *
A copy of your responses will be emailed to the address you provided.
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