JOW Scona Daily Health Checklist
If an individual answers yes to any of these questions, they will not be allowed to participate in OSC activities for a specified period of time.
Sign in to Google to save your progress. Learn more
Your Name: *
Date: *
MM
/
DD
/
YYYY
Has anyone in your household traveled outside of Canada in the last 14 days? *
Has the swimmer in JOW Scona been in close contact with someone who has travelled outside of Canada in the last 14 days? *
Required
If you have answered “YES” to any of the above, please refer to the following information. If you have answered "NO" proceed to the next question.
- Your swimmer is required to quarantine for 14 days from the last day of exposure.
- If the swimmer is participating in the Alberta COVID-19 International Border Pilot Project, they
must comply with the program restrictions at all times.
- If the swimmer develops any of the symptoms listed below, use the AHS Online Assessment Tool or call Health Link 811 to
determine if testing is recommended.

AHS Online Assessment Tool found here: https://myhealth.alberta.ca/Journey/COVID-19/Pages/COVID-Self-Assessment.aspx
Does your swimmer in JOW Scona have any of the following symptoms?
If your swimmer has any of the symptoms above, please refer to the following information. If none of the symptoms above pertain to your swimmer in JOW Scona, please proceed to the next question.
- The swimmer is to isolate for 10 days from onset of symptoms.
- Use the AHS Online Assessment Tool or call Health Link 811 to arrange for testing and to receive
additional information on isolation.

AHS Online Assessment Tool found here: https://myhealth.alberta.ca/Journey/COVID-19/Pages/COVID-Self-Assessment.aspx
Does your swimmer in JOW Scona have any of the following symptoms?
If your swimmer has only checked off ONE of the symptoms in the question above, please refer to the following information.
- Keep your swimmer home and monitor for 24 hours.
- If their symptom is improving after 24 hours, they can return to OSC activities when they feel
well enough to go. Testing is not necessary.
- If the symptom does not improve or worsens after 24 hours (or if additional symptoms emerge), use
the AHS Online Assessment Tool or call Health Link 811 to check if testing is recommended.

AHS Online Assessment Tool found here: https://myhealth.alberta.ca/Journey/COVID-19/Pages/COVID-Self-Assessment.aspx
If your swimmer has checked off TWO OR MORE symptoms in the question above, please refer to the following information.
- Keep your swimmer home.
- Use the AHS Online Assessment Tool or call Health Link 811 to determine if testing is recommended.
- Your swimmer can return to OSC activities once their symptoms go away as long as it has been at
least 24 hours since their symptoms started.

AHS Online Assessment Tool found here: https://myhealth.alberta.ca/Journey/COVID-19/Pages/COVID-Self-Assessment.aspx
If your JOW swimmer has not checked off any of the symptoms listed above, your swimmer may attend their regularly scheduled practices.
Time in: *
Time
:
Time Out *
Time
:
If your child is experiencing any symptoms from the lists above, do not bring them to visit a continuing care or acute care facility for 10 days from when symptoms started/until symptoms resolve (whichever is longer), unless they receive a negative COVID-19 test result and feel better.
PLEASE NOTE: This checklist is a daily screening and needs to be completed every day before practice in order to keep careful track of any athlete in the JOW Scona group to keep the entire group & club as healthy as possible.
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms