Alberta Health Daily Checklist

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To ensure that Nose Creek Swim Association can comply, to the extent possible, with the Alberta Health orders and the Swim Alberta/Swim Canada guidelines. We are required to keep daily records of anyone attending any of our NCSA training or functions in the event of an outbreak. Your assistance in advance will help speed up the health checklist process. Please fill out the following form for each session your swimmer is attending. Please fill out one form for each swimmer.

A reminder if you or anyone in your household are feeling unwell, please do not attend the program.

Email *

Swimmer's Full Name *

Emergency Contact Number *

Swimmers Squad *

Training Pool *

Date of Session *

YYYY

Alberta Health Daily Check List

Please fill out this very quick survey prior to every practice. Attendees should fill out this checklist prior to participating in the activity or program. If the individual answers YES to any of the questions, they must NOT be allowed to attend or participate in the activity or program. Children and youth will need a parent to assist them to complete this screening tool.

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)

None of the Above

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

Yes

Required

Has the attendee had close contact* with a confirmed case of COVID-19 in the last 14 days? *

Yes

Required

Has the attendee had close contact with a symptomatic** close contact of a confirmed case of COVID-19 in the last 14 days? *

Yes

Required

Definitions

* * Face-to-face contact within 2 meters. A health care worker in an occupational setting wearing the recommended personal protective equipment is not considered to be a close contact.
** ‘Ill/symptomatic’ means someone with COVID-19 symptoms on the list above.

Completion

If you have answered “yes” to any of the above questions do not participate. Go home and use the AHS Online Assessment Tool to determine if testing is recommended.

We thank you for taking the time to complete this form. Please note all NCSA members attending a training session must complete these questions each day as part of their daily screening. By submitting the form you agree that you have provided your honest answer, to the best of your knowledge.

ENJOY YOUR SESSION!!!

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

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