2021 Competitive -- COVID-19 Daily Pre-screening Questionnaire

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You will be required to submit this questionnaire *the morning of* your competitive training, prior to entering the building.

Full Name *

Body Temperature - must be taken the morning of *

Are you experiencing any of the following symptoms? *

Fever

Chills

Cough

Shortness of breath or difficulty breathing

Sore throat

Loss of appetite, decreased sense of taste or smell

Fatigue or feeling sluggish

None of the above

Required

Have you traveled outside of Leeds and Grenville area within the last 14 days? *

Yes

Have you been in close physical contact with someone who is ill, or been in close physical contact with someone with a confirmed case of COVID-19? *

Yes

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