Covid-19 Pre-Training Screening
For all of our safety, please fill this out to the best of your abilities 24 hours prior to your session. Please seek immediate medical attention if you have any of the recognised COVID-19 symptoms. If your circumstances change at any point, please notify us immediately.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Have you experienced any of the following symptoms in the past 14 days?
Rows
Yes
No
A temperature of 38°C+
1
2
Unexplained body aches or pain
3
4
A dry, persistent cough
5
6
Shortness of breath
7
8
Chills with or without body aches
9
10
Recent loss of sense of smell or taste
11
12
Unusual fatigue
13
14
Have you, at any point, tested positive for Covid-19?
Yes - if so, please obtain permission from your GPP before training
No
Does anybody in your household or support bubble have Covid-19 or the symptoms listed above?
Yes
No
Have you been in close contact in the last 14 days with somebody who has the symptoms of, or has tested positive, for Covid-19?
Yes
No
Are you classed as a vulnerable or high risk individual in relation to Covid-19?
Yes - extremely vulnerable
Yes - moderately vulnerable (please obtain permission from your GP before training)
No
As part of the Test and Trace programme, we are asked to securely store your contact details for 21 days. These would only be passed on in the unlikely event of a positive test to help stop the spread of the virus and while strongly encouraged, participation is voluntary. Are you happy for your details to be stored for these purposes?
Yes
No, I'd like to opt out
Signature
Submit
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