NASC Tyke - COVID-19 Pre-Screening Questionnaire (OHF)
This survey will take approximately 4 minutes to completed.

IMPORTANT: THIS MUST BE COMPLETED ON THE SAME DAY AS YOUR SCHEDULED ACTIVITY

If you Answer "YES" to any of the questions, you are NOT to attend your session.  Thank you.
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Email *
Team Name *
Player Name *
Date of Activity *
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Time of Activity *
Facility *
Do you have a fever? *
Chills? *
Cough that is new or worsening (continuous, more than usual)? *
Barking cough, making a whistling noise when breathing (croup)? *
Shortness of breath (out of breath, unable to breathe deeply)? *
Runny nose, sneezing or nasal congestions (Not related to seasonal allergies or other known causes or conditions)? *
Lost sense of taste or smell? *
Pink eye (conjunctivitis)? *
Headache that's unusual or long lasting? *
Digestive issues (nausea/vomiting, diarrhea, stomach pain)? *
Muscle aches, extreme tiredness this is unusual (fatigue, lack of energy)? *
In the past 14 days, have you had close physical contact with someone who has tested positive for COVID-19?  [Close physical contact means 1) being less than 2 meters away in the same room, workspace of area for over 15 minutes; 2) living in the same home.] *
In the past 14 days, have you been in close physical contact with a person who is either:  currently sick with a new cough, fever, or difficulty breathing (acute respiratory illness); OR, Returned from outside Canada in the last 14 days.  (Essential workers who cross the Canada-US border regularly are exempted)  [Close physical contact means 1) being less than 2 meters away in the same room, workspace of area for over 15 minutes; 2) living in the same home.] *
Have you travelled outside of Canada in the last 14days?  (Essential workers who cross the Canada-US border regularly are exempted) *
In the past 14 days have you been directed by Public Health to self-isolate? *
Name of Parent/Guardian staying in the arena, if applicable.  This does not include the coaching staff. Enter NA if no parent/guardian staying. *
Your Phone/Cell Number *
As a parent / guardian or team representative, do any of the above pre screening questions apply to yourself? (Answer NO if you have no symptoms) *
A copy of your responses will be emailed to the address you provided.
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