Player Name
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Date:
Fever: YesNo
Fatigue: YesNo
Cough: YesNo
Sneezing: YesNo
Aches and Pains: YesNo
Runny or Stuffy Nose YesNo
Sore throat: YesNo
Diarrhea: YesNo
Headaches: YesNo
Shortness of breath: YesNo
Have you recently been in close contact with anyone who has exhibited any symptoms? YesNo
Have you recently been in contact with anyone who has tested positive for COVID - 19? YesNo
Have you recently traveled to a restricted area that is under a Level 2, 3, or 4 Travel Advisory according to the U.S. State Department? Including: China, Italy, Iran, and most countries in Europe. YesNo