World Rugby (Midwest) COVID-19 Symptom Checker
This form must be utilized prior to attending a training or competition event to ensure that you are free from COVID-19 symptoms and pose limited risk to others. (Update: 03/12/2021)
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Are you currently diagnosed with or believe you may have COVID-19? *
Name *
Have you had any of these symptoms of COVID-19 in the past ten (10) days?
High temperature (fever or chills)? *
A new, continuous cough? *
A new, unexplained shortness of breath? *
Have you been in contact with a COVID-19 confirmed or suspected case in the previous ten (10) days? *
New, unexplained muscle pain or body aches? *
New loss of taste or smell? *
New vomiting or diarrhea? *
If you have answered 'YES' to any of these questions, you should stay home and inform your manager or medical practitioner. You should follow local current Public Health guidance.                                                                                  CDC Guidelines require any person diagnosed with COVID-19 to self-isolate for 10 days after onset of symptoms or from the day of testing positive and to go at least 24 hours fever free without the use of fever-reducing medications.
By checking the below box, I attest that all questions were answered honestly to the best of my ability. *
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