COVID-19 Symptoms Checklist for Coaches/Participants:

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All skaters, coaches, and staff must complete this questionnaire before the training session. Preferably less than 2 hours BEFORE the session for an accurate assessment.

If an individual answer “YES” to any of the following questions, they are not permitted to participate in any in-person skating activity for a minimum of 14 days and must receive a negative test before returning to skating in- person activities.

Skater's First and Last Name *

Does the skater have any of the below symptoms? *

Fever (Feeling hot to the touch, or a temperature greater than 37.8 C)/chills

Cough that is new/worsening/continuous

Shortness of Breath/Difficulty Breathing

Sore Throat

Difficulty Swallowing

Runny Nose, Sneezing or Nasal Congestion(not related to allergies)

Decrease Loss of Taste/Smell

NONE OF THE ABOVE

Has the skater, or anyone in your household: *

1. Travelled outside of Canada in the last 14 days, or been in close contact with someone that has?

2. Experienced any of the above symptoms in the last 14 days?

3. Been in close contact, without the use of ppe, with someone with a confirmed case of Covid-19?

4. Been in close contact, without the use of ppe, with someone who is being investigated as a suspected case of COVID-19?

NONE OF THE ABOVE

First and last name of the attending guardian. *

Contact information of the attending guardian? We are asking for this information, to be able to contact you promptly if there has been an accident/issue that requires your attention. Format: 9051234567 *

If you have answered yes to any of the questions, the skater is NOT permitted on the ice.

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