SPMS Officials Health Check Questionnaire

Thank you for helping us maintain a safe and healthy environment for our swimmers and coaches! Once you complete the questionnaire, you will receive a confirmation email with a pass or no pass, depending on your answers.

In the past 24 hours, have you or anyone in your household experienced any of the following symptoms: cough, shortness of breath or difficulty breathing, chills, repeated shaking with chills, muscle pain, headache, sore throat, loss of taste or smell, diarrhea, feeling feverish or measured temperature greater than or equal to 99.0 degrees Fahrenheit.

Has anyone in your household recently been in contact with anyone who has exhibited any of the previously mentioned symptoms?

Have you recently (preceding 14 days) been in close contact with anyone who has lab confirmed positive for COVID-19?

By checking the box below, I certify that I have answered the above questions truthfully. I further acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed to or infected by COVID-19, or other viral or bacterial infection, while participating in any of the Events, and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I agree that if I have a fever, cough, feel short of breath, have any other symptoms, have knowingly been exposed to a communicable disease such as COVID-19 or have traveled to or from a highly impacted area, I will not attend an Event for at least two weeks after exposure or symptoms have subsided or I have returned from a highly impacted area. In addition, if I discover I have been exposed to a suspected or positive case of COVID-19 or have tested positive for COVID-19, I will notify the coach or club administrator immediately.