Hustle Softball Fall 2020 Health Assessment Survey Question Title * 1. Next Scheduled Practice/Game Date / Time Date Question Title * 2. Player ( Full Name) Question Title * 3. Guardian ( Full Name) Question Title * 4. Team Name Hustle Softball Question Title * 5. Coach (Full Name ) For Coaches Only Question Title * 6. VISITING TEAMS- Player Name (Full Name) Question Title * 7. VISITING TEAMS- Guardian Name ( Full Name) Question Title * 8. VISITING TEAMS- Player Name (Full Name) Question Title * 9. Do you have a new cough that you cannot attribute to another health condition? Yes No Question Title * 10. Do you have new shortness of breath that you cannot attribute to another health condition? Yes No Question Title * 11. Do you have any of the following symptoms: Fever (100.4 degrees or higher), chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell? Yes No Question Title * 12. Have you come into close contact (within 6 feet) with someone who has a laboratory-confirmed Covid-19 diagnosis in the past 14 days? Yes No Question Title * 13. In the last 14 days, have you been in a State listed on the NJ Travel Advisory List? Click for the NJ Travel Advisory List. Yes No Question Title * 14. If you answered YES to any of the screening questions, immediately contact your doctor and stay home until advised otherwise by your doctor. I will follow CDC recommendations. Submit and Thank You
