RBC COVID-19 HEALTH SCREENING

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This form must be completed by every coach and player prior to every practice or game as required by the NJ DOH and the RBC COVID-19 Preparation and Reopening Plan. If this form is not received before your practice or game, the player/coach will not be able to participate. IF YOU ANSWER YES TO ANY OF THE QUESTIONS BELOW, YOU ARE NOT PERMITTED TO PARTICIPATE IN ANY RBC ACTIVITIES.

Thank you for your cooperation.

Ridge Baseball Club

Email *

Team Name *

First Name of Player *

Last Name of Player *

Does the player have a temperature of 100.4 or higher? *

Yes

Has the player experienced any flu-like symptoms or symptoms of COVID-19 in the past 14 days? *

Yes

Has any household member experienced any flu-like symptoms or symptoms of COVID-19 in the past 14 days? *

Yes

Has the player tested positive for COVID-19 in the past 14 days? *

Yes

Has the player come in close contact with anyone diagnosed with COVID-19 in the past 14 days? *

Yes

Has the player traveled to any state on the NJ Travel Advisory List in the past 14 days? (for a current list of states, see: https://covid19.nj.gov/faqs/nj-information/travel-information/which-states-are-on-the-travel-advisory-list-are-there-travel-restrictions-to-or-from-new-jersey) *

Yes

Name of Person filling out this form *

Signature *

Checking this box serves as my signature and indicates that the answers above are truthful to the best of my knowledge

Required

Submit

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