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SPOTSY PREMIER SOCCER & FUTSAL

Questionnaire


DAILY COVID-19 Screening Questionnaire

 

*Review the questions, if you answer yes to any of the questions, at this time you will not be able to enter this building.

A face covering is required if you are entering an FCCWO/FCA Building.

1. Have you been in contact with someone known to have Coronavirus (COVID-19) within the last 14 days?

2. Have you been advised by a public health official that you may have been exposed to Coronavirus (COVID-19) within the last 14 days?

3. Indicate if you currently have any of the listed symptoms or have had any of the listed symptoms within the last 14 days, which cannot be attributed to another health condition.

a. Fever (100.4 or greater)

b. Chills

c. Cough

d. Shortness of breath or difficulty breathing

e. Fatigue

f. Muscle or body aches

g. Headache

h. New loss of taste or smell

i. Sore throat

j. Congestion or runny nose

k. Nausea or vomiting

l. Diarrhea

4. Have you traveled outside the United States in the last 14 days?

5. Have you traveled by cruise or riverboat in the last 14 days?

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