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Athlete Health Check

Required for entry to each session – submit on day of training

Date

Athlete Name

Parent/Guardian Name (If Athlete is Under 18)

Phone Number

Email

Has athlete had any of the following in last 14 days - high temperature (over 37.8oC), - new continuous cough/worsening existing cough, - loss/change in sense of taste/smell?

Yes No

Is athlete showing any other Covid-19 signs -hoarseness, runny nose, sneezing, shortness of breath, sore throat, wheezing, tiredness? (Although these are common symptoms of other illnesses, they may be signs an individual has been infected by Covid-19 and it is vital you do not infect teammates, family, friends or the general public)

Yes No

Has athlete been in contact with anyone with or suspected of having COVID-19 in the last 48 hours?

Yes No

Has anyone in athlete's household had COVID-19 symptoms in the last 14 days?

Yes No

Has athlete been advised to self-isolate due to a 3rd party from another setting (i.e school, another club) being infected with COVID-19?

Yes No

Does athlete have any underlying health conditions that would put them at further risk should the contract COVID-19? (Cardiovascular problems, High blood pressure, Diabetes, Chronic kidney/liver disease, Compromised immunity diseases, BMI 40+)

Yes No

Thank you for completing this and helping us to keep our athletes, families and coaches as safe as possible x

Warrington Cheer Storm

Unit 8 Bank Quay Warrington
Slutcher's Lane
Warrington
Chesire
WA1 1PJ

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