Rochester JNQ health screening form

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Complete the morning of the race, prior to coming to the race venue.
Fill out for each racer, coach, support person, or volunteer attending.

Skier name (first, last) *

Phone # *

In the past 10 DAYS, have you experienced any of these symptoms that are NEW or UNUSUAL for you? *

Yes. DO NOT COME TO THE RACE and contact your doctor for recommendations about testing, quarantine. and medical care.

In the past 2 WEEKS, have you, a household member or close contact tested positive for COVID? A close contact is anyone you've been within 6 feet of for > 15 minutes over 24 hours (regardless of masking). *

Yes. DO NOT COME TO THE RACE. Call YOUR county COVID hotline (585-753-5555 in Monroe) for required quarantine and testing.

In the past 2 WEEKS, have you traveled outside of New York for more than 24 hours (excluding CT, MA, NJ, PA, VT)? *

Yes. DO NOT COME TO THE RACE. Follow the NY State requirements for quarantine, testing, reporting - https://coronavirus.health.ny.gov/covid-19-travel-advisory

If you have answered NO to all of the above questions, you are cleared to come to the race. Masking is required at all times when you are not racing.

If you have answered yes, then contact your doctor or the county health department COVID hotline (585-753-5555) for required quarantine, testing, and medical clearance before returning to practice.

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