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Step Rock ASC. Health Screen Survey for Returning to Training

You will be aware of the ongoing outbreak of COVID-19. Step Rock ASC is adhering to guidance from Scottish Government and Public Health Scotland in containing the virus and ensuring a safe environment for swimmers, volunteers, family members and FSLT staff. The club’s Lead COVID-19 Officer is Sharon Hedley (covidofficer@steprock.org.uk; 07769 754915).

As one of our measures, we are seeking to identify any potential cases at the earliest opportunity to avoid any contacts/spread. The research to date for this novel virus suggests that transmission appears to be during symptomatic phase, and as such, identifying those with symptoms and isolating them should reduce risk significantly.

Please answer the following questions prior to travelling to any club-based activity. This Health Screen Survey should be completed once, before returning to training or again if returning to training after a period of illness or circumstances change.

Secured
1

Please type in the full name of swimmer/ volunteer

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2

Please tick the box which describes the PRIMARY role you have at Step Rock ASC

e.g. If you are a swimmer who also coaches, please select Swimmer
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3

Which squad are you in?

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You will now be asked a series of YES/ NO questions. Please read them carefully and answer them honestly.

4

Have you had any of the following symptoms in the last 48 hours

For a full list of symptoms and more information: https://www.nhsinform.scot/illnesses-and-conditions/infections-and-poisoning/coronavirus-covid-19
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5

Have you had a known exposure to anyone with confirmed or suspected COVID-19 in the last two weeks?

e.g. close or prolonged contact/ household member
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6

Have you been asked to isolate within the past 14 days?

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7

Have you travelled to any country (outside of the UK) in the last 14 days?

Please check the relevant information for the location and whether 14 day self isolation is required before returning to training at: https://www.gov.scot/publications/coronavirus-covid-19-public-health-checks-at-borders/pages/exemptions/
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8

If your answer to any of the above questions (4, 5, 6, 7) is YES, please notify the Lead Covid Officer by phone. You may need to seek the appropriate medical or further advice before restarting training. You should NOT travel to the pool until this has been done. Do you agree to adhere to these measures?

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9

Do you agree to inform the club if you have any physical or mental health conditions that the club are not already aware of that would affect your ability to train/ return to training?

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10

Please use the box below to provide any further information which you feel would be useful for your return to the pool

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11

Please indicate below that you understand all of the previous questions and have answered them correctly

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