Oakridge Soccer Club | Volunteer Screening

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

You are completing this form as part of the Oakridge Soccer Club's COVID-19 Screening Process. This form must be completed for every session a registered volunteer is taking part for a team that plays under the Oakridge Soccer Club banner.

All submissions will be logged by the Oakridge Soccer Club for the purpose of Contact Tracing as outlined by the Government of Ontario and Ontario Soccer.

Once you have completed the survey, a copy of your responses will be sent to you via email. Please forward this copy to your team Manager or designated official for tracking.

Thank you.

The Oakridge Soccer Club

Email *

What is your name? *

What team are you associated with? (Age group & team name) Ex: U10G Lightning *

What is your role with the team? (Select One) *

Date of next session you will be attending? *

YYYY

Have you had close contact (within the last 5 days) with a person who has tested COVID-19 positive? *

Yes

If yes, was this person a family member? Then you can not attend any soccer sessions and must isolate for 5 days. Please refer to the Government of Ontario Self-Assessment Tool, you will get a recommendation on what to do next: https://covid-19.ontario.ca/self-assessment/. *

I understand & agree to this directive.

Does not apply as I have not had a close contact

If you replied 'No' to not having close contact with someone who was COVID-19 positive, as of this moment, do you have any of the following: *

Fever/chills

Cough

Difficulty breathing

Shortness of breath (even when sitting/walking)

Sore throat

Runny or congested nose (not allergies)

Unusual level of fatigue

Nausea, vomiting, diarrhea, or loss of appetite

Feeling unwell for unknown reason

Loss of smell

Unusual rash

Unexplained behavioural change

Conjunctivitis

None of the above

Required

I acknowledge that if I answered yes to any of the above questions other than close contact without symptoms, I will not participate in/attend any Oakridge Soccer Club team event (practice, training, scrimmage, game etc) and will notify the team Head Coach and/or team Manager of their absence. *

Yes

Required

Today's Date *

YYYY

Time of Survey Completion *

Time

Version: 4Mar2022

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of The Oakridge Soccer Club. Report Abuse

Forms