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Synchronized Skating Qualifying Competition
COVID-19 Protocol Questionnaire
Team Information
Team Name:
*
Team Level
*
Preliminary
Pre-Juvenile
Juvenile
Open Juvenile
Intermediate
Novice
Junior
Senior
Collegiate
Open Collegiate
Adult
Open Adult
Masters
Open Masters
Competition Attending
*
2022 U.S. Synchronized Skating Championships
2022 Eastern Synchronized Skating Sectional Championships
2022 Midwestern Synchronized Skating Sectional Championships
2022 Pacific Coast Synchronized Skating Sectional Championships
What is your team's travel status?
*
We are traveling to the competition in less than 12 hours.
We are traveling to the competition in more than 12 hours.
We have already checked in to the competition.
Contact Information
Please provide the information for one contact for your team who will be responsible for communicating with the member of your competition's medical team responsible for COVID-19 protocol. This must be a coach or team manager.
Team Contact Name
*
Role
*
Coach
Team Manager
Phone Number
*
Email Address
*
Travel & Competition Information
Date of departure for competition:
*
+
Date of first competition activity (i.e. practice ice):
*
+
How is this team traveling to the competition?
*
Plane
Team Bus
Individual Cars
What is your housing situation for this competition?
*
Skaters will be sharing rooms with other skaters.
Skaters will be in independent rooms (with/without chaperones).
We will not be using a hotel to attend this competition.
COVID-19 Information
Has a member of your team tested positive for COVID-19 (skater, coach, team manager, team service personnel) and it is less than 10 days until your departure date for the competition?
*
Yes, a member of our team has tested positive for COVID-19 less than 10 days prior to our departure to the competition.
No, but a member of our team has come in close contact with someone who has tested positive for COVID-19.
No, but a member of our team has become symptomatic since arriving at the competition.
What is the date of the positive test or date of symptom onset (whichever is earlier)?
*
+
What is the role of or relationship with the person who tested positive?
*
Has this person come in close contact (less than 6 feet for a period of time of 15-minutes or more) with the skaters on your team? NOTE: if the positive test came from a skater, this answer should be yes.
*
Yes
No
Was the individual who tested positive around the team (i.e. at practice) within 48 hours before the positive test or onset of symptoms?
*
Yes
No
Are all team personnel for this team (coaches, team service personnel, team managers) up-to-date on their COVID-19 vaccinations?
*
Yes
No
Unknown
Are all skaters for this team, regardless of age eligibility, up-to-date on their COVID-19 vaccinations?
*
Yes
No
Unknown
Have skaters from this team previously tested positive between 11 and 90 days of departure and completed a 10-day isolation period?
*
Yes
No
Unknown
If unvaccinated skaters (who have not previously tested positive for COVID-19) are not permitted to attend the competition based on medical evaluation, will this effect your ability to compete with the minimum number of skaters required for your level?
*
Yes
No
Unknown
Have all other members of the team (excluding the person already identified as testing positive, if applicable) been able to produce a negative COVID test?
*
Yes
No
Unknown
When were the tests taken?
*
Are any other members of your team (excluding the person already identified as testing positive) displaying any symptoms of COVID-19: fever/chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, diarrhea?
*
Yes
No
Please briefly describe the training environment at home: when was the team's last practice together prior to someone testing positive? Does the team regularly wear masks during all on and off ice practices? Do the coaches maintain social distancing from the skaters? Etc. Etc.
*
Did the infected individual come into contact with any other teams scheduled to compete?
*
Yes
No
Please complete an additional form for each team impacted.
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