USAC.25 Safety QuestionnaireA safety questionnaire must be filled out separately for each driver and handler attending. Race Date * MM DD YYYY Driver/Handler Name * First Name Last Name The safety of our drivers, competitors and USAC.25 members remain a priority. To prevent the spread of COVID-19 and reduce the potential risk of exposure to club members, officials and competitors, please complete this simple health screening questionnaire. In the last 72 hours have you had a fever and/or taken medication for a fever? * Yes No In the last 7 days have you had symptoms of a lower respiratory illness (cough, difficulty breathing, etc..)? * Yes No In the past 14 days have you been in close contact with a person known/suspected to have COVID-19 and/or have you been diagnosed with COVID-19? * Yes No Current Temperature * Is your current temperature 100.1 or higher? * Yes No Date Complete * MM DD YYYY Thank you!
