COVID-19 Case Reporting Form
Please use this form to report confirmed case of COVID within Sting Soccer Club Membership - this includes immediate household family members of Administrators, Coaches & Players
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
The positive case is?
*
A Player
A Coach
An Immediate family member of player / coach living in same household
Other
Is the Positive Individual Fully Vaccinated
*
Yes
No
Don't know
Division
*
Austin
Corpus Christi
DFW
West Texas
San Antonio
Nebraska
Sting Team Name
*
Sting Coach Name
*
When was this case confirmed?
*
-
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
Symptoms?
*
Yes
No
When did Symptoms start?
-
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
What type of Symptoms?
Coughing
Fever
Having shortness of breath
Feeling persistent pain or pressure in the chest
Fatigue
Other
When was the positive individual last in attendance at Sting Activity?
*
-
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
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 in the Sting environment for 15 mins or more un-masked and indoors? If yes, please provide information here- (names of individuals or entire group?)
Has the positive case had any close contact with others on your team / player in club outside of training / game environment? (Sleepover, hanging out, car pooling etc.)
*
YES
NO
Does the player concerned have a sibling in program?
*
YES
NO
Submit
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