Covid Checklist (English)

Please fill in the form below before you go to the stadium. This data will only be used for contact tracing and will be stored for two weeks, after we will remove them immediately. Only the competent authorities have access to this data. Thank you in advance!

KLIK HIER VOOR DE NEDERLANDSTALIGE CHECKLIST

Personal information

First name

Last name

Date of birth

Email address

Telephone number

Function on matchday

Covid-safe check

You meet one of these conditions

Symptoms check

Please indicate the symptoms you are experiencing:

None of the below
Dry cough
Shortness of breath
Respiratory problems
Chest pain or chest pressure
Affected taste
Affected odour
Muscle pain
Fatigue
Sniffle nose
Sore throat
Headache

By submitting this form, you declare to have filled in the Covid Checklist fully and correctly. Please contact mm@essevee.be if you have any questions.

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