HWSA COVID-19 Self Screener Questionnaire

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All HWSA swimmers must complete this self-screening questionnaire daily and present it upon arrival or complete this Google form before each practice.
A wide range of symptoms have been reported among those who have tested positive for COVID-19. These symptoms range from mild to severe illness. Symptoms may 2-14 days after virus exposure.

Fever (temperature at or greater than 100.4 degrees) *

Yes

Cough *

Yes

Shortness of Breath or Difficulty Breathing *

Yes

Chills *

Yes

Fatigue *

Yes

Muscle & Body Aches *

Yes

Headache *

Yes

Sore Throat *

Yes

New Loss of Taste or Smell *

Yes

Congestion or Runny Nose *

Yes

Nausea *

Yes

Vomiting *

Yes

Diarrhea *

Yes

Outside of the pool environment in the last 14 days, have you had close contact with or cared for someone diagnosed with COVID-19 or that had all the currently known symptoms of COVID-19 that are listed above? *

Yes

If the answer is YES to any of the above questions, DO NOT come to the pool.

Swimmer's Name: *

Parent's Name *

Date *

YYYY

Group *

Group 1

Group 2

Group 3

Group 4

Elite

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