EFAC U18 AAA Alberta Health Daily Checklist - PLAYER (UNDER 18 YEARS)
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.

Overview:
This checklist applies for all children, as well as all students who attend kindergarten to Grade 12, including
high school students over 18. Children should be screened every day by completing this checklist before
going to school, child care or other activities. Children may need a parent or guardian to assist them to
complete this screening tool.

As the COVID-19 pandemic continues to evolve, this screening tool will be updated as required.
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Email Address *
Player Name *
Date of Ice Time or Activity *
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Question 1:
Have you (the player attending the ice/activity):
Traveled outside Canada in the last 14 days?  When entering or returning to Alberta from outside Canada, individuals are legally required to quarantine for 14 days unless enrolled in the Alberta COVID-19 International Border Pilot Project *
Had close contact with a case of COVID-19 in the last 14 days? Face-to-face contact within 2 metres for 15 minutes or longer, or direct physical contact such as hugging *
If you answered “YES” to any of the above:
- You are required to quarantine for 14 days from the last day of exposure.
       ->If you are participating in the Alberta COVID-19 International Border Pilot Project, you must comply with the program restrictions at all times.
- If you develop any symptoms, use the AHS Online Assessment Tool or call Health Link 811 to determine if testing is recommended.

If you answered “NO” to both of the above:
- Proceed to question 2.

Question 2:
Do you have any new onset (or worsening) of the following core symptoms:
Fever: Temperature of 38 degrees Celsius or higher *
Cough: Continuous, more than usual, not related to other known causes or conditions such as asthma *
Shortness of breath: Continuous, out of breath, unable to breathe deeply, not related to other known causes or conditions such as asthma *
Loss of sense of smell or taste: Not related to other known causes or conditions like allergies or neurological disorders *
If you answered “YES” to any symptom in question 2:
- You are 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.

If the child answered “NO” to all of the symptoms in question 2:
- Proceed to question 3.
Question 3:
Do you have any new onset (or worsening) of the following other symptoms:
Chills: Without fever, not related to being outside in cold weather *
Sore throat/painful swallowing: Not related to other known causes/conditions, such as seasonal allergies or reflux *
Runny nose/congestion: Not related to other known causes/conditions, such as seasonal allergies or being outside in cold weather *
Feeling unwell/fatigued: Lack of energy, poor feeding in infants, not related to other known causes or conditions, such as depression, insomnia, thyroid dysfunction or sudden injury *
Nausea, vomiting and/or diarrhea: Not related to other known causes or conditions, such as anxiety, medication or irritable bowel syndrome *
Unexplained loss of appetite: Not related to other known causes or conditions, such as anxiety or medication *
Muscle/joint aches: Not related to other known causes or conditions, such as arthritis or injury *
Headache: Not related to other known causes or conditions, such as tension-type headaches or chronic migraines *
Conjunctivitis: Commonly known as pink eye *
If you answered “YES” to ONE symptom in question 3:
- Stay home and monitor for 24 hours.
- If your symptom is improving after 24 hours, you can return to ice/activity when you 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.

If you answered answered “YES” to TWO OR MORE symptoms in question 3:
- Stay home.
- Use the AHS Online Assessment Tool or call Health Link 811 to determine if testing is recommended.
- You can return to ice/activities once your symptoms go away as long as it has been at least 24 hours since your symptoms started.

If you answered “NO” to all questions:
- You may attend ice/activities.
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