Smiling Tri Track Health Screener

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It is essential that you complete this form before attending the track session. The session is covid secure in line with British Triathlon Federation guidance.

Date

YYYY

Today or at any point in the last 14 days have you had ...(If anyone answers yes to this question, NHS advice is, they should get a test to check if they have coronavirus as soon as possible. Stay at home and do not have visitors until they get their test results - only leave home to get a test.)

Yes

A fever?

A persistent dry cough?

Loss of taste?

Loss of smell

Clear selection

Pre Session Fitness Related Questions - if you answer yes to any of the below questions please seek further medical advice before training.

Yes

Have you recently suffered any form of injury?

Do you have any form of underlying illness, such as asthma, epilepsy, suffering from any immune deficiency, receiving any form of medication which might affect you in the session?

Do you have chest pain when performing physical activity?

Are you pregnant or have you given birth in the last 6 months?

Do you have a bone or joint problem that causes you pain when exercising?

Have you had recent surgery?

Do you have any other limitations that must be addressed when developing an exercise plan (i.e. diabetes, high blood pressure, high cholesterol, arthritis, back problems etc.)?

Receiving any form of medication that might affect you during the session?

Yes

Have you recently suffered any form of injury?

Do you have any form of underlying illness, such as asthma, epilepsy, suffering from any immune deficiency, receiving any form of medication which might affect you in the session?

Do you have chest pain when performing physical activity?

Are you pregnant or have you given birth in the last 6 months?

Do you have a bone or joint problem that causes you pain when exercising?

Have you had recent surgery?

Do you have any other limitations that must be addressed when developing an exercise plan (i.e. diabetes, high blood pressure, high cholesterol, arthritis, back problems etc.)?

Receiving any form of medication that might affect you during the session?

Clear selection

I certify that I believe I am fit to train and I take part in the session at my own risk

Yes

Clear selection

Name

Email address

I have paid

By cash on the day

By bank transfer - Mrs K Offord Sort code - 090128 Account No - 69436829

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Submit

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