EFAC U18 AA Alberta Health Daily Checklist - ADULT 18 YEARS AND OLDER
Pursuant to the AHS and Hockey Edmonton requirements, this form must be submitted ON THE SAME DATE AS THE ICE TIME/ACTIVITY, and no later than 2 hours prior to that scheduled ice time/activity. Please DO NOT complete the night before as the date will be incorrect and the player will not be allowed to participate.

If you have traveled outside Canada in the last 14 days, follow the Government of Canada Travel, Testing, Quarantine and Borders instructions, including any requirements for exempt travelers related to attending high- risk environments.

If within the last 10 days, you have been notified by Public Health that you are a case of COVID-19, you are
required to isolate as per Public Health instructions.

As the COVID-19 pandemic continues to evolve, this screening tool will be updated as required.
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Full Name *
Email Address *
Date of Ice Time or Activity *
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Question 1:
Have you been a household contact* of a case of COVID-19 in the last 14 days?  *A household contact: a person who lives in the same residence as the case OR who has been in frequent, long-duration, close-range interaction with a case of COVID-19.  For example, someone who is a caregiver or an intimate or sexual partner of a COVID19 case.
Clear selection
If you answered “YES” to  question 1 and you are NOT fully immunized:
- You should stay home for 14 days from the last day of exposure and monitor for symptoms. If you have
symptoms, proceed to question 2

If you  answered “NO” to question 1:
- Proceed to Question 2
Question 2:
Do you have ANY new onset or worsening of ANY of the following symptoms: Fever*, Cough*, Shortness of Breath*, Runny nose*, Sore throat*, Chills, Painful swallowing, Nasal congestion, Feeling unwell/Fatigued, Nausea/Vomiting/Diarrhea, Unexplained loss of appetite, Loss of sense of taste or smell*, Muscle/Joint aches, Headache, Conjunctivitis (commonly known as pink eye) *
If you answered YES to ANY symptom in question 2:
- Stay home
- Use the AHS Online Assessment Tool or call Health Link 811 to arrange for testing and to receive additional
information on isolation.
- Individuals with fever, cough, shortness of breath, runny nose, sore throat or loss of sense of taste or smell are required to isolate for 10 days as per CMOH Order 39-2021
OR
- Receive a negative COVID-19 test and feel better before returning to activities.

If you answered NO:
- You may attend ice/activities.
   
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