IHUK COVID-19 Health Questionnaire

Great Britain Ice Hockey
Covid Health Question
This Health Questionnaire should be filled out NO earlier than 24 hours prior to the start of the camp.
Are you a Player Or IHUK Staff Member.
Player's Name
First NameLast Name
Parent's/Guardian Name Consenting If Under 18
First NameLast Name
Is the Parent/Guardian consenting above attending?
Adult Accompanying Player
First NameLast Name
Select GB Team
Date
DayMonthYear
2 digit day, 2 digit month, 4 digit yearDateHourMinutes
Have you had a confirmed COVID-19 diagnosis?
If ‘Yes’, please provide details below:
Have you had any symptoms (listed below) in keeping with COVID-19 in the last 14 days?
Fever, New persistent dry cough, Shortness of breath, Loss of taste or smell, If ‘Yes’, please provide details below:
Have you had a known exposure to anyone with confirmed or suspected COVID-19 in the last 14 days? (e.g. close contact, household member)
If ‘Yes’, please provide details below:
Do you live with or will you knowingly come into close contact with someone who is currently ‘shielding’ or otherwise medically vulnerable if you return to the training environment?
If ‘Yes’, please provide details below:
Have you been advised by NHS Track and Trace to self isolate, or who is required to quarantine following return from overseas in line with current government guidance
If ‘Yes’, please provide details below:
I confirm that should I develop COVID-19 symptoms, or have been in contact with an individual showing COVID-19 symptoms, that I will notify IHUK by emailing your team manager
I understand that, where required by current COVID-19 guidelines issued by the Government, my data will be shared with NHS Track and Trace where appropriate
I further acknowledge that IHUK cannot guarantee that I will not become infected with Covid-19. I understand that the risk of becoming exposed to and/or infected by Covid-19 may result from the actions, omissions, or negligence of myself or others, including, but not limited to, coaches, ice rink staff, and other players and their familes
I will comply as far as appropriate and practiable with IceSheffield Covid-19 guidelines
Take Photo Of Your Covid Test Results.
Any Other Details
Should be Empty:

Great Britain Ice Hockey