Spectator Health Questionnaire
This questionnaire must be completed by each spectator prior to attending a Woolwich Wild activity.

The team staff will ask you to confirm that you have completed the questionnaire and answered no to all questions before you will be permitted to participate in the activity.  

Are you currently experiencing any of these issues? Call 911 if you are:
1. Experiencing severe difficulty breathing (struggling for each breath, can only speak in single words)
2. Experiencing severe chest pain (constant tightness or crushing sensation)
3. Feeling confused or unsure of where you are
4. Losing consciousness

If you are in any of the following at risk groups, we ask that you speak with your physician prior to participating.
1. 70 years old or older
2. Getting treatment that compromises (weakens) your immune system (for example, chemotherapy, medication for transplants, corticosteroids, TNF inhibitors)
3. Having a condition that compromises (weakens) your immune system (for example, diabetes, emphysema, asthma, heart condition)
4. Regularly going to a hospital or health care setting for a treatment (for example, dialysis, surgery, cancer treatment)


The answer to all questions must be “No” in order to participate in each on-ice activity.

If an individual has answered “Yes” to any of these questions, they are not permitted to participate in any on-ice or off-ice activities or attend as a spectator.  Please call your trainer immediately and let them know that you have responded positively to questions in the Health Screening Questionnaire.  

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Your first name: *
Your last name: *
Your phone number: *
Your email address: *
Last name of player you are here to watch: *
Age group of player you are here to watch: *
What colour is the Training Group? *
What day of the week is the ice time? *
What time is the ice time? *
Time
:
Do you have a fever? (Feeling hot to the touch, a temperature of 37.8C or higher.) *
Do you have chills? *
Do you have a cough that is new or worsening?  Continuous, more than usual, not related to other known causes or conditions (for example, COPD). *
Do you have a barking cough, making a whistling noise when breathing (croup, not related to other known causes or conditions)? *
Do you have shortness of breath?  Out of breath, unable to breathe deeply , not related to other known causes or conditions (for example, asthma). *
Do you have a sore throat?  Not related to other known causes or conditions (for example, seasonal allergies, acid reflux). *
Do you have difficulty swallowing?  Painful swallowing, not related to other known causes or conditions. *
Do you have a runny nose, sneezing or nasal congestion (not related to seasonal allergies or other known causes or conditions)? *
Do you have a decrease or loss of taste and smell?  Not related to other known causes or conditions (for example, allergies, neurological disorders). *
Do you have pink eye?  Conjunctivitis, not related to other known causes or conditions (for example, reoccurring styes). *
Do you have a headache that is unusual or long lasting?  Not related to other known causes or conditions (for example, tension-type headaches, chronic migraines). *
Do you have digestive issues (nausea/vomiting, diarrhea, stomach pain)?  Not related to other known causes or conditions (for example, irritable bowel syndrome, anxiety in children, menstrual cramps). *
Do you have muscle aches that are unusual or long lasting?  Not related to other known causes or conditions (for example, a sudden injury, fibromyalgia). *
Do you have extreme tiredness that is unusual (fatigue, lack of energy)? *
Do you fall down often (older people)? *
Are you sluggish or do you have a loss of appetite?  (For young children) *
In the last 14 days, have you been in close physical contact with someone who tested positive for COVID-19? *
In the last 14 days, have you been in close physical contact with a person who either: Is currently sick with a new cough, fever, or difficulty breathing; OR Returned from outside of Canada in the last 2 weeks? *
Have you travelled outside of Canada in the last 14 days? *
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