COVID Self-Reporting Survey

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* 1. (First, Last) Name

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* 2. What team are you on?

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* 3. Do you have any of the following symptoms: Fever, chills, dry cough, difficulty breathing, respiratory illness, or acute loss of taste or smell?

Yes

No

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* 4. Have you tested positive for Covid-19 in the past two weeks?

Yes

No

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* 5. Have you informed your team of your Covid-19 results?

Yes

No [We will inform your team if you choose this option]