Player Self Screening Form | Lothian Phoenix WBC

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Covid-19 Self Screening Form

How are you feeling today?

First Name

Last Name

Email

Are you experiencing any of the following symptoms:

High Temperature

A new, continuous cough

Change or loss of tast and smell

I am waiting on the results of a Covid-19 test result

Initials

Date

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

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