EmailMe Form - WISA Player CDC Questions

Today's Date *
MM / DD / YYYY
Name *
First Last
Phone *
### - ### - ####
WISA Team *

Team Name
1. Have you experienced any of the following symptoms in the past 48 hours: fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, diarrhea? *
Yes (if yes, you are not eligible to play today)
No
2. Have you been in close physical contact in the last 14 days with: anyone who is known to have laboratory-confirmed COVID-19 OR anyone who has any symptoms consistent with COVID-19? *
Yes (if yes, you are not eligible to play today)
No
Close physical contact is defined as being within 6 feet of an infected/symptomatic person for
a cumulative total of 15 minutes or more over a 24-hour period starting from 48 hours before illness onset (or, for asymptomatic individuals, 48 hours prior to test specimen collection).
3. Are you isolating or quarantining because you may have been exposed to a person with
COVID-19 or are worried that you may be sick with COVID-19? *
Yes (if yes, you are not eligible to play today)
No
4. Are you currently waiting on the results of a COVID-19 test? *
Yes (if yes, you are not eligible to play today)
No
5. In the last 10 days, have you completed any OUT OF STATE TRAVEL and not met the county specific testing requirements? E.g., OUT OF STATE TRAVEL – you did NOT receive a NEGATIVE COVID-19 test from a trusted testing partner no earlier than 72-hours prior to your flight to Hawaii. *
Yes (if yes, you are not eligible to play today)
No
Travel is defined as any trip that is overnight AND on public transportation (plane, train, bus,
Uber, Lyft, cab, etc.) OR any trip that is overnight AND with people who are not in your
household.
6. Certification *

check

I certify that my responses are true and correct.
By typing your name below, you are signing this survey electronically and you agree that your electronic signature is the legal equivalent of your manual signature. *
First Last

Powered by

EMF Contact Form