COVID 19 Screening – Limitless Performance

Please fill out this quick survey prior to your visit to help everyone stay safe and healthy.

COVID Screening Form

Name*
First Last
Email*
Do you have a fever?*
- Yes
- No
Do you have any of the following signs or symptoms?*
- New onset of cough
- Worsening chronic cough
- Shortness of breath
- Sore throat
- Difficulty breathing
- New loss or decrease in sense of taste or smell
- Runny nose
- Sneezing (not allergy related)
- Hoarse voice
- Nasal congestion
- Chills
- Difficulty swallowing
- Headache
- Unexplained fatigue or malaise
- Nausea/vomiting, diarrhea, abdominal pain
- Yes
- No
Have you been in contact with anyone with COVID-19, acute respiratory illness, or travelled outside of Canada in the past 14 days?
- Yes
- No
Did you wear the required PPE according to the type of duties you were performing when you had close contact with a suspected or confirmed case of COVID-19?
- Yes
- No
Signature
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We're sorry, due to the answers you provided above you are not able to work out today. Please consider an online workout.
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