Craftsbury Outdoor Center Pre-Race Health Screening

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All racers must complete this health survey within 24-48 hours of racing at the Outdoor Center and AGAIN on the day you plan on racing at the Outdoor Center, as mandated by the state of Vermont.

Full Name *

Email *

Club/Team *

Are you a Vermont resident? *

Yes

No (no attendence)

Town in which you reside *

Role at the event *

Do you currently have a pending COVID19 test? *

Yes (no attendance until test results come back negative)

Have you had a positive COVID19 test in the last 14 days? *

Yes (no attendance)

Have you previously contracted and recovered from COVID19? (If so you are not barred from racing, but we want to be sure that past COVID positives are approved by primary care providers) *

Yes

In the last 24 hours, have you or any of your household members had any of the following symptoms?

Fever (temperature of 100.0F or above), felt feverish, or had chills? *

Yes

Cough? *

Yes

Sore throat? *

Yes

Difficulty breathing? *

Yes

Fatigue? *

Yes

Headache? *

Yes

New loss of smell/taste? *

Yes

Any other signs of illness? *

Yes

In the past 14 days, have you had close contact with a person known to be infected with COVID-19? *

Yes

In the past 14 days, have you tested positive for COVID-19? *

Yes

In the past 14 days, have you traveled outside of Vermont? *

Yes

If you answered yes to any of the symptom questions, DO NOT come to the Outdoor Center for your race start. Please contact race director Ollie Burruss about a refund.

I agree to leave the venue if asked by the COVID Coordinator or Race Director. Furthermore I commit to notifying the Craftsbury Outdoor Center if I test positive for COVID19 within 48 hours after the race. *

Yes

No (no attendance)

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