GIG HARBOR CANOE AND KAYAK RACING TEAM

GHCKRT Self-Screening Checklist

This form is to be completed by all GHCKRT athletes and staff daily and prior to instruction/work. 

 

1. Do you currently have any of the following symptoms? YES NO 

  1. Fever 

  1. Cough 

  1. Sore Throat 

  1. Shortness of breath 

  1. Fatigue 

  1. Muscle Aches 

  1. New loss of taste or smell 

 

2.  Have you had any of the symptoms listed above in the past 14 days?  YES NO 

 

3.  Have you traveled outside the State of Washington in the last 14 days?  YES NO 

 

4. Have you had CLOSE PERSONAL CONTACT with anyone who has been diagnosed with COVID 19 in the past 14 days? (Per criteria below) YES NO 

  1. Within 6’ for greater than approximately 10 minutes 

  1. Had direct contact (coughed on, sneezed on) 

 

5Is your temperature (taken today) less than 100 Deg F. YES NO 

 

6. If you answered YES to any of the above questions, contact your coach or supervisor before continuing with GHCKRT in-person lessons or practices.