RKC's COVID-19 SCREENING QUESTIONNAIRE

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COVID-19 SCREENING QUESTIONNAIRE that must be completed by the student before attending EACH session. Your participation and honesty is important to contain the spread of this disease and ensure the safety of our fellow dojo members.

NAME *

ID NUMBER *

1. I am attending for the purpose of: *

Current member attending class

Attending an introduction class

Family or existing member

Visiting / Spectator

Required

2. My current temperature is: *

3. Do you have a fever (above 38°C) or history of fever and chills? *

Yes

Required

4. Do you have a cough? *

Yes

Required

5. Are you experiencing any difficulty breathing? *

Yes

Required

6. Are you experiencing loss of smell or taste? *

Yes

Required

7. Are you experiencing any body aches? *

Yes

Required

8. Are you experiencing any nausea, vomiting or diarrhea? *

Yes

Required

9. Are you experiencing fatigue or weakness? *

Yes

Required

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