COVID Screening - Non Team related events

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Please complete the form below on the day of but no more than 12hrs prior to your scheduled ice time/session.

In order for proper contact tracing, a new form must be complete each time you enter the facility.

Email *

Participant Name *

Group *

For Call-Ups / Call-Overs and Other: Which team are you playing/volunteering for?

Does the participant or spectator listed above currently have any Covid-19 related symptoms in accordance with current Ottawa Public Health guidelines? (example: fever, cough, difficulty breathing/shortness of breath, loss of taste/smell, nausea/vomiting, abdominal pain/diarrhea or muscle pain, headache, runny nose, sore throat). *

Yes

Required

Has the participant or spectator listed above knowingly been exposed to or been in contact with anyone who has tested positive for Covid-19, in the past 14 days? (Mark “No” if you are fully vaccinated AND have been cleared by Ottawa Public Health regarding self isolation) *

Yes

Required

In the last 14 days have you traveled outside Canada? If exempt from federal quarantine requirements or are fully vaccinated, and meet specific conditions as set by the federal government, select NO. *

Yes

Required

By agreeing, I acknowledge that if at any time after submission of this form and my actual session that if my health situation with respect to Covid -19 has changed I will refrain from attending the session. *

I AGREE

I DISAGREE

Required

By agreeing, I acknowledge that all information provided above is accurate and I have agreed to follow the policies and procedures put in place by the City of Ottawa or Beckwith Township upon entering the facility. *

I AGREE

I DISAGREE

Required

If you answered YES to any of the screening questions above, please self isolate right away, contact your health care provider or visit OttawaPublicHealth.ca/Coronavirus for more information.

All spectators, volunteers and on-ice helpers, 12 and older, must be fully vaccinated (second dose plus 14 days) in order to enter the facility. Please carry proof of vaccination and photo ID with you at all time. *

I AGREE, and will provide proof upon request

I DISAGREE, and will not enter the facility

Required

Send me a copy of my responses.

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