Please read the Physical Condition Management Check Sheet and Health Checklist carefully, and fill in all sections.
Physical Condition Management Check Sheet
After filling in this check sheet, please submit it at runner check-in. Please be aware that if you fail to submit it, or if
you answer Yes to any of the following, you will not be able to take part.
Have you had any of the following
Items to check before taking part
YesNoYesNo
on, or since, February 12?
Do you currently have COVID-19 or
1 other disease and/or are receiving
medical treatment for the above?
Have you been identified as a close
contact of someone with COVID-19
2 and/or are you under a healthobservation period on the day of runnercheck-in?

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*Except where the cause is clearly identifiable as being something other than
COVID-19• The purpose of this document is to confirm the health status of those taking
part in the Kyoto Marathon, in order to prevent the spread of COVID-19, etc.
• Personal information entered here will be stored in accordance with strict
controls, and will only be used for the purpose of understanding status ofhealth and for required communication.
• Should anyone with COVID-19 or suspected of having it be discovered,information may be provided as necessary to public health centers or similar.

1 Sore throat*□□

2 Cough*□□

3 Excessive phlegm*□□

4 Runny or blocked nose*□□

5 Headache*□□

6 Sluggishness□□

7 Temperature of 37.5°C or above□□

8 Difficulty breathing□

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9

Loss of taste or smell (or otherabnormality)

Health Check List
A health check is necessary to participate in Kyoto Marathon. Please be sure to check your health condition and thenparticipate in the marathon responsibly.
Please check the appropriate box.
If any of the below items apply (1〜5), please consult yourprimary-care doctor in order to participate in the race.
Please have a physical checkup and a heart exam with yourprimary-care doctor.

The below items (6〜9) are risk factors linked to thedevelopment of Myocardial infarction or Angina.
If applicable, please consult your primary-care
doctor and stabilize
these conditions before the race.

I have heart disease (Myocardial infarction, Angina,
1 Myocardiosis, Valvular disease, Irregularheartbeat).

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6 I have high blood pressure (Hyperpiesia).

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7 I have high blood sugar (Diabetes).

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2 I have fainted unexpectedly (Fainting spells).

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3 I had chest pain dizziness during exercise.

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I have relatives who died unexpectedly from heartdisease.

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5I have not had a physical examination for over ayear.

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8I have a high cholesterol count or highneutral fat count (Hyperlipemia).

9 I smoke cigarettes.

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Primary-Care Doctor means a doctor close to you
who manages and provides advice on yourhealthcare. Please decide your primary-care doctor
and receive consultation regarding examinations
and participating in the race.

(Japan Association of Athletics Federations, Medical Committee)

Should you require medical care or other help, we will refer to the following when making decisions (theydo not constitute conditions on participation).
Underlying illnesses and risk of serious illness

Please circle the number of any of the following four statements that apply to you.

1. I will be aged 65 or above on the day of the marathon.
2. I am currently undergoing dialysis.
3. I am currently taking immunosuppressants, anticancer drugs, or similar medication.
4. I have one or more of the following underlying diseases:
Diabetes, heart failure, respiratory illness (chronic obstructive pulmonary disease, etc.), angina pectoris, cardiac
arrhythmia, cerebral infarction
Other illness:
Pledge and Physical Condition Management Check Sheet Confirmation
The information I have entered on
Name Please enter the name of the runnerYes□
the Physical Condition Management
Check Sheet is correct.