IHUK COVID-19 Health Questionnaire

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*

DateHourMinutes

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

Great Britain Ice Hockey