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Covid Questionnaire :
Do not complete this form until the day of the event !!
Personal Details
Full Name
ID Number
Cellphone
Email
Address
Do you or have you had any of the following symptoms over the past 7 days?
No
Yes
Fever above 38 degrees or night chills and sweating
No
Yes
Coughing or wheezing
No
Yes
Any difficulty breathing
No
Yes
Loss of taste or smell
No
Yes
Body aches
No
Yes
Nausea, vomiting or diarrhoea
No
Yes
Fatigue or weakness
In the last 14 days, in your community:
No
Yes
Were you in close contact or living with any person with flu like symptoms?
No
Yes
Were you in close contact or living with a person with confirmed COVID-19 or a person under investigation for COVID-19?
No
Yes
Have you worked in or visited a healthcare facility where patients with COVID-19 infections are being treated?
Close contact means you were face-to-face (less than 1m) from a person, or you were in a closed space (car, taxi, home or office) with a person for at least 15 minutes.
I understand and agree to inform the club’s COVID-19 Compliance Officer or coach should I display and/or suffer from any of the above symptoms. I understand that I enter the premises at my own risk.