USA All-Star Champs - COVID Screening Form - FLORIDA REGION OF USA VOLLEYBALL

FLORIDA REGION OF USA VOLLEYBALL

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INSTRUCTIONS: Please complete this form daily in the morning before arriving at the OCCC.

Note: Anyone that cannot answer "NO" to all of the questions below should not attend the event and should notify events@floridavolleyball.org immediately.

* Indicates required field

Name *

First

Last

Email *

Date *

Have you experienced any of the following symptoms in the last 24 hours?

Fever Greater than 100.4 *

Yes No

Cough *

Yes No

Shortness of Breath *

Yes No

Runny Nose *

Yes No

Headache *

Yes No

Muscle or Joint Pain from Illness *

Yes No

Sore Throat *

Yes No

Nausea, Vomiting, Diarrhea *

Yes No

Loss of Taste or Smell *

Yes No

Have you been in close contact (6 feet or less for 15 minutes or more) with anyone who has tested positive for COVID-19 or been ill in the last 14 days? *

Yes No

Are you currently restricted by a medical provider/Department of Public Health due to a positive COVID-19 test? *

Yes No

Submit

Copyright (c) 1982-2021
Florida Region of USA Volleyball, Inc.
All Rights Reserved
Steve Bishop, Executive Director/President
Mary Andrew, Board Chair
Indoor & Outdoor Volleyball since 1982!

E-MAIL REGION OFFICE
ABOUT US
CONTACT US

MEMBERSHIP
About
Contact
Indoor VB
Outdoor VB
PARA VB
- Team Florida Sitting All-Stars
Officials
Find a Club Near You
For Parents! Parent Information Page
For Club Directors! Club Information Page
Florida Colleges
Forms
Links
Region Store
AVCA Insights
Support USAV in Florida