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FLFA Volunteer Health Check
Covid-19 Health Check
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* Indicates required question
Email
*
Your email
Name:
*
Your answer
Date:
*
MM
/
DD
/
YYYY
What station did you volunteer at today? (Check all that apply)
*
Main Gate
Cutter Team Check-In & Entrance
Away Team Check-In & Entrance
Exit
Snack Stand
Security Patrol
Required
1) Have you experienced a fever of 100.4 degrees For greater in the past 14 days?
*
Yes
No
2) Have you received a positive result from a Covid-19 test within the past 14 days?
*
Yes
No
3. Have you been in contact with anyone while they had Covid-19 or symptoms of Covid-19 in the past 14 days?
*
Yes
No
4. In the past 14 days, have you, or someone you have been in contact with, traveled outside your state/province/country or to an area with restrictions due to Covid-19?
*
Yes
No
5. In the past 14 days, have you experienced any of the following new symptoms not attributed to another health condition? Select all that apply.
*
Cough
Loss of smell or taste
Runny nose
Shortness of breath
Sore throat
None of the avobe
Required
Thank you for your cooperation, understanding, and support! YOU ROCK! GO CUTTERS!!!
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