CRSL 2020 COVID-19 Questionnaire

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This form must be completed for each player prior to each practice and game.

Email *

Date *

YYYY

Player First Name *

Player Last Name *

Name of person completing form *

Team Name *

Is the player experiencing any of the following symptoms: *

YES

Fever (≥ 100.4°F)

Cough or shortness of breath

Sore Throat

Chills

Muscle Aches or Rigors

Headache

New loss of taste or smell

Abdominal pain, nausea, vomiting or diarrhea

Have you had close contact with someone who is currently sick?

Have you been diagnosed with COVID-19 in the past three weeks or have reason to believe you have COVID-19?

Have you traveled or had close contact with anyone who has traveled internationally in the last 14 days?

YES