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Covid Return Form
If you have come in contact with someone or have come down with Covid 19... Please fill out the following form before returning and submit proof of Covid Negative test.
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Name
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Your answer
Email
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Your answer
Please fill out the following!
Have you experienced the symptoms listed below in the last 72 hours?
Temperature greater than 100 degree Fahrenheit or alternating chills/shakes?
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Yes
No
New difficulty breathing? (that can not be resolved with a prescribed inhaler)
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Yes
No
New or worsening cough?
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Yes
No
New loss of smell, taste, or appetite?
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Yes
No
New muscle aches throughout your body? (Not workout related)
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Yes
No
New difficulty staying awake?
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Yes
No
New headache?
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Yes
No
New sore throat?
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Yes
No
New diarrhea?
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Yes
No
Did you or have you tested for Covid?
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Yes
No
If yes when?
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Your answer
When did you come in contact with Covid?
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Your answer
Did you come in contact with someone who had Covid... or are you Tested Positive for Covid?
I came in Contact
I tested positive
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After coming in contact with someone with Covid have you had any symptoms?
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Yes
No
If Yes, What were your symptoms?
Your answer
If Yes, How many days have you been symptom free?
Your answer
How many days have you quarantined yourself?
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Your answer
Is anyone in your home currently sick?
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Yes
No
What was the date you tested Negative for Covid before your return to the gym
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MM
/
DD
/
YYYY
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I understand I must quarantine and follow CDC guidelines before my return to regular activities. I have answered the questions honestly and truthfully.
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