COVID-19 Health Screening Questionnaire
All individuals entering the facility are required to complete the below COVID-19 screening questionnaire prior to entering the facility.
Sign in to Google to save your progress. Learn more
Email *
Last Name of Player / Visitor *
First Name of Player / Visitor *
Visitor Description *
Event Location *
Event Type *
Home Team Name, if applicable *
Visiting Team Name (if game)
1.  Is your temperature greater than 100.0 degrees *
2.  Do you have any signs of sickness (e.g., fever or chills, cough, shortness of breath, difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea, vomiting, diarrhea) *
3.  Have you tested positive for COVID-19 or come into contact with someone that tested positive COVID-19 in the past 14 days *
4.  Are you currently under quarantine due to COVID-19 exposure *
5.  Are you returning from travel to any of the states listed on the NYS quarantine list *
I agree and acknowledge that I and my athlete will comply with any and all Schenectady County requirements that as a condition of ongoing participation includes full cooperation with County case investigations and contact elicitation and adherence to isolation and quarantine orders. I further submit that all answers herein are the truth. *
Game Protocols
1)      Health Screenings - All players, coaches, and visitors must fill out a COVID-19 Health Screening Questionnaire (Google Form) no more than 2 hours before entering SCRF.  https://forms.gle/2w44Ae8DL3AmJP7j9.  After completion of the form, a confirmation will be sent to the email address you entered on the form.  Players and visitors must show evidence of completion upon rink entry (printed copy email receipt on phone).

2)      Temperature Checks (Self-Performed at Home) - All players, coaches, and visitors must take their own temperatures no more than 2 hours before entering SCRF.  Individuals with temperatures ≥ 100 degrees are not allowed in the rink.

3)      Player Entering and Exiting - Players will enter one of the front doors as directed by the health screener.  Players will immediately head to an available chair in their assigned section to finish dressing.  Players will remain seated until they are directed by their coach to enter the ice.  Players will exit through the same door they entered.

4)      Players Arrival and Departure Times – a) Players will be allowed into the rink 7 minutes before game time; b) Goalies and Head Coaches will be allowed into the rink 15 minutes before game time; c) Players must leave the rink within 7 minutes after game

5)      Face Coverings - Players, Coaches, Scorekeeper/Time Clocker Operators, Referees are required to wear masks at all times, including during the game and when sitting on the bench.

6)      Dressing - Players should enter the rink in full hockey gear and ready to play.  Players are permitted to put on their skates inside the rink.  No full-size hockey equipment bags are allowed in rink.  Players may bring in a small bag (e.g., reusable grocery bag).  Goalies are allowed to get dressed inside the rink.

7)      Locker Rooms - Locker rooms are closed.  Folding chairs are available outside the locker rooms for player use (30 chairs based on first-come-first-serve basis)

8)      Spectators - One spectator is allowed per player.  Spectators are allowed to enter the rink after the players take the ice and must leave immediately at the end of the game via the back door (by Zamboni).  Spectators are only allowed in the stands and cannot congregate along the boards.  All spectators must wear proper face coverings and stand six feet apart.

9)      Coaches on Bench - Maximum of three coaches are allowed on the bench.

10)  Play Maximums - Maximum of 18 players on the bench on the bench.

11)  Penalty Box - Penalty boxes are closed for youth hockey games (Penalties will be taken on player bench).   High school teams are permitted to use the penalty boxes.

12)  Water Bottles - Players must bring their own water bottlers.  Water bottle sharing is not permitted.  Water bottles/filling station is closed.

13)  Hand contact – Hand contact (e.g., handshakes, high-fives) is not allowed, including end-of-game handshake line.

14)  Restrooms - Restrooms will be open.

15)  Food - No food is allowed in the rink

16)  Off-Ice Interaction – Teams can conduct social-distanced activities (e.g., team meetings, dryland activities) outside as long as the activities are supervised by a Coach and 6 foot social distancing is maintained.

17)  Referees – a) Referees are subject to all rules above; b) Referees will be provided electronic whistles (available in front lobby or scorer’s box); c) Locker Room #1 will be available to referees.
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy