OSC Daily Health Checklist

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If an individual answers yes to any of these questions, they will not be allowed to participate in the sport.

Your Name *

Date *

YYYY

Do you/your child have any new/onset (or worsening) of any of the symptoms:

Fever

Cough

Shortness of Breath / Difficulty Breathing

Sore Throat

Chills

Painful Swallowing

Runny Nose / Nasal Congestion

Feeling Unwell / Fatigued

Nausea / Vomiting / Diarrhea

Unexplained loss of appetite

Loss of sense of taste or smell

Muscle / Joint aches

Headache

Conjunctivitis (Commonly known as pink eye)

Has the person attending the activity/facility traveled outside of Canada in the last 14 days? *

Yes

Required

Have you/your child had close unprotected* contact (face-to-face contact within 2 metres/6 feet) with someone who has traveled outside of Canada in the last 14 days and who is ill**? *

Yes

Required

Have you/your child attending the program or activity had close unprotected contact (face-to-face contact within 2 metres/6 feet without appropriate personal protective equipment.) in the last 14 days with someone who is ill? (“ill” means someone with COVID-19 symptoms on the list above.) *

Yes

Required

Have you/your child or anyone in your household been in close unprotected contact (face-to-face contact within 2 metres/6 feet without appropriate personal protective equipment.) in the last 14 days with someone who is being investigated or confirmed to be a case of COVID-19? *

Yes

Required

Did you answer ‘no’ to all Health Monitoring questions prior to coming to practice? *

Yes

Time-in *

Time-out *

If you've been in contact with any individuals who have left the country recently or been in contact with a COVID-19 carrier, go home and use the AHS Online Assessment Tool to determine if testing is recommended.

You must comply with all public health orders and guidelines. In completing this assessment the individual pledges that they have not been exposed to COVID-19 in the past 14 days and that they are taking reasonable steps to avoid being exposed. It also states that Olympian Swim Club reserves the right to remove the participant from the facility or from Olympian Swim Club programming for any reason.

Further Details regarding public health orders and guidelines can be found here: https://www.alberta.ca/covid-19-orders-and-legislation.aspx

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