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RSSC COVID-19 Contact Tracing Form
Updated as of 11/6/2020
Oneida Health Department has required our facility to have a method of doing Contact Tracing. We have been asked for ALL of our members to please fill out this form each time you enter our center.
This form is for ALL Players, All Spectators, and Chaperons.
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* Indicates required question
Your name (Parents and players can put both names on one form)
*
Your answer
Contact email
*
Your answer
Contact phone number
*
Your answer
Do you have any Covid-19 Symptoms? Such as Fever or chills, CoughShortness 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).
*
If YES =You are not permitted to enter the Facility
If No =You are able to enter the Facility
Are you here to Watch or Play or Working
*
Watch
Play
Working
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