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Foothill Running Club USD Health Screen Form
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First Name
*
Your answer
Last Name
*
Your answer
Are you experiencing any symptoms such as current or recent fever (100.4° or higher), chills, cough, shortness of breath or respiratory illness, sudden lack of taste or smell, or sudden onset of unexplained gastrointestinal illness? *
*
Yes
No
Have you been in close contact** with any person who has been infected with COVID-19 within in the last 14 days? ** CLOSE CONTACT is defined as: Being within approximately 6 feet of a COVID-19 case for a prolonged period of time; close contact can occur while caring for, living with, visiting, or sharing a healthcare waiting area or room with a COVID-19 case or having direct contact with infectious secretions of a COVID-19 case (being coughed on).
*
Yes
No
If you have answered "yes" to the previous two Questions, please do not attend practice and return home,
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