Lancashire Clubs Autumn Friendly League Health Declaration Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

This form must be completed up to 24 hours before attending any netball event facilitated by the Lancashire Clubs Friendly League. The purpose of the questionnaire is to screen for any symptoms of COVID19 infection. Our aim is promote and maintain the health and safety of our netball family.

Please help us achieve this by answering accurately and honestly.

Today, or at any point over the last 7 days has any of your players, coaches or umpires participating in the league had any of the symptoms below?

A FEVER? Touch your chest and back. If they feel hotter than usual, you may have a high temperature. You may also have other symptoms such as feeling shivery (chills). *

Yes

A NEW CONTINUOUS COUGH? Continuous: means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours. *

Yes

ANY LOSS OR CHANGE TO SENSE OF TASTE OR SMELL? *

Yes

Has any member of your player's family or someone they have been in contact with, tested positive for COVID19 in the last 14 days? *

Yes

Have any of your players been notified by NHS Test and Trace that you are a close contact of someone with known COVID19 infection in the last 14 days? *

Yes

Club Name *

Team Name/Age Group *

Club Representative's Full Name *

We as a club have made all of the appropriate enquiries into our players health. To my knowledge the information provided is accurate and correct. *

Confirmed

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms