Dingwall ASC Health Screening Survey

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You will be aware of the ongoing outbreak of COVID-19. Dingwall Amateur Swimming Club are adhering to guidance from Scottish Government and Public Health Scotland in containing the virus and ensuring a safe environment for athletes and staff.

As one of our measures, we are seeking to identify any potential cases at the earliest opportunity to avoid any contacts/spread. The research to date for this novel virus suggests that transmission appears to be during symptomatic phase, and as such, identifying those with symptoms and isolating them should reduce risk significantly

Please answer the following questions (YES / NO) prior to travelling to your return to training and submit to the club as per their instructions. This Health Survey should be completed before returning to training only, unless there is a change in health circumstances in which case the form should be completed before the next session that the athlete is attending.

Athlete/Staff Name *

Squad *

A Squad

B Squad

C Squad

Development Squad

I am a Coach/Volunteer

I have attended a Club briefing and/or received a copy of the Club's COVID-19 Return to Training Information (or watched the Club information video) understand the information and agree to comply with it? *

Yes

Have you had any of the following symptoms below in the last 48 hours? *

Please select all that apply

Fever/High Temperature (37.8C or greater)

Shortness of breath

Loss of, or change in, sense of smell or taste (anosmia)

Abnormal fatigue or tiredness

Abnormal muscle or joint pain

Sore throat

Diarrhoea

Vomiting or nausea

I have had none of the symptoms above in the last 48 hours

Required

Have you had any known exposure to anyone with confirmed or suspected COVID-19 in the last two weeks? (e.g. close contact, household member) *

Yes

Have you had confirmed COVID-19 infection or any symptoms in keeping with COVID-19 in the last three months? *

Yes

Do you have any underlying medical conditions? *

Examples include: chronic respiratory conditions including asthma, chronic heart, kidney, liver or neurological conditions; diabetes mellitus; a spleen or immune system condition; currently taking medicines that affect your immune system such as steroid tablets

Yes

Do you live with or will you knowingly come into close contact with someone who is medically vulnerable if you return to the training environment? *

Yes

Any additional comments?

If you have had any of the symptoms listed above in the last 48 hours or if the answer to any of the above questions is YES, please notify the Lead COVID-19 Officer by phone. You should seek appropriate medical advice before restarting training. You should NOT travel to the pool until this has been done.

Athlete/Staff Signature *

Please type your signature as J.Smith

Parent/Guardian Signature (if under 16)

Please type your signature as J.Smith

Submit

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