COVID-19 Case Reporting Form
Please use this form to report a suspected or confirmed case of COVID.
Name of Person Reporting
*
First Name
Last Name
Reporter Phone Number
*
-
Area Code
Phone Number
Reported Name
*
First Name
Last Name
Reported Phone Number
*
-
Area Code
Phone Number
Division
*
Austin
Corpus Christi
Louisiana
North Texas
Pennsylvania
San Antonio
Sting Team Name
*
Sting Coach Name
*
Confirmed Cases
When was this case confirmed?
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Month
-
Day
Year
Date
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Comments
Suspected Cases
Report Date & Time
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Month
-
Day
Year
Date
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
When did you first suspected?
-
Month
-
Day
Year
Date
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Why are you reporting this person?
Coughing
Fever
Having shortness of breath
Feeling persistent pain or pressure in the chest
Having confusion or inability to arouse
Just came from abroad, carrying highly risk of COVID-19
Have the guidelines been followed within your scheduled sessions?
YES
NO
Have you individually maintained (coach) distancing from all of your teams / players?
YES
NO
Has the player concerned had any close contact with others on your team / player in club? (Sleepover, hanging out etc.)
YES
NO
The CDC defines a "positive exposure" as "any individual who has been within 6ft of a positive individual for 15 mins or more" - has there been any instance whereby the positive case has been within 6ft of another individual for 15 mins or more? If yes, please provide information here:
Does the player concerned have a sibling in program?
YES
NO
Comments
Games/Scrimmages
Has your team played any scrimmages, league games or tournament games in past 14 days prior to date of positive test?
YES
NO
If Yes, please list out who have you have played against? (Age Group, Team Name and Coach needed)
Location of games
Submit
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