BLST Coach Clinic COVID-19 Prescreening Form 5/15/2021
Due to the ongoing COVID-2019 pandemic, coaches, aides, swimmers, administrators, and volunteers are required to complete this form prior to participating in a Ben Lomond Swim Team (BLST) activity (practice, swim meet, team meeting, spirit night, or other team function. Your participation is subject to approval upon completion of this form. These rules are being enforced to keep our team members. family and staff, as well as the rest of your loved ones, safe and healthy.

This form must be completed, one for EACH person, on the day (not day before) and by 12:00 PM (NOON) of your team practice/meet/activity. Failure to complete by 12 pm disqualifies you from participation that day.
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Email *
Last Name of participant (one form for each) *
First Name of participant (one form for each) *
TODAY's Date? *
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What is your role? *
1. Are you generally feeling SICK TODAY? *
2.  Have you had a temperature of 100.0°F or greater sustained for several hours or days? *
3.  Have you had any of the following (as new issue; more than just occasional, and not a diagnosed medical issue, allergy or asthma related) ? Shaking, chills, feeling feverish, Cough, Sore Throat Shortness of breath, Muscle pan all over body (not from sports or physical activity), Headache (beyond occasional), Diarrhea or vomiting today or within the last three days. *
4.  Have you had close contact with someone who has tested positive for, or suspected to have, COVID-19 or the flu in the last 14 days OR suspected positive but not tested *
5. Have you , or has anyone in your household, travelled outside the US in the past 14 days and not quarantined (for 10 days, and not had the COVID vaccine? *
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