1 | Have you ever fainted? | | During exercise | Yes / No |
| | Following exercise | Yes / No |
| | Unrelated to exercise | Yes / No |
2 | Do you experience dizzy turns? | | During exercise | Yes / No |
| | Following exercise | Yes / No |
| | Unrelated to exercise | Yes / No |
3 | Do you experience palpitations? | | Yes / No |
4 | Do you experience chest pain, heaviness or tightness? | | During exercise | Yes / No |
| | Following exercise | Yes / No |
| | Unrelated to exercise | Yes / No |
5 | Do you feel that you are more breathless or more easily tired than your team mates? | | Yes / No |
6 | Is there a family history of heart disease? | | Yes / No |
7 | Has there been unexplained death or deaths due to heart disease in young family members? | | Yes / No |