COVID-19 Pre-Trip Questionnaire INSTRUCTOR

Name of Instructor*

NAME of person completing this form AND RELATION to Instructor (only needed if not "self")

What is your current temperature?*

In the past 14-days or are you currently experiencing any of these symptoms? (check all that apply)*

In the last 14 days, what is PARTICIPANT'S known exposure to COVID-19 and its symptoms?*

Direct contact with someone experiencing symptoms of COVID-19
Direct contact with someone who is currently positive (active) COVID-19
No known direct contact to someone currently positive with COVID-19 or anyone experiencing symptoms
Unsure

If so, when?

In the last 14 days, what is OTHER HOUSEHOLD member's known exposure to COVID-19 and its symptoms?*

Direct contact with someone experiencing symptoms of COVID-19
Direct contact with someone who is currently positive (active) COVID-19
No known direct contact to someone currently positive with COVID-19 or anyone experiencing symptoms
Unsure

If so, when?

In the last 14 days, have you had a COVID-19 test administered? If so, please list date and result.*

I understand and agree to abide by the 5 Commitments that TASP, the Telluride Ski Area and the Telluride Community are committed to. This includes (1) wearing a double layered face mask, (2) maintaining 6+’ of physical distancing, (3) minimizing group size, (4) washing hands frequently & (5) staying home when sick.*

Agree
Disagree

I certify that the above is truthful and accurate to the best of my knowledge. (INITIAL here)*

CAPTCHA

TASP INSTRUCTOR Pre-Trip Screening