Covid-19 Screening (Burford Minor Hockey)

Thank you Everyone! Please remember to:

Print Covid-19 Screening

Please Pre Screen before arriving to participate.

Contact

Please Provide Contact Info.

Location

Date of Event

Time of Event

Assesment

Do you have a fever greater than or equal to 38°C (100.4°F) and/or a new onset of cough or difficulty breathing?
YesNo
Have you returned from travel outside of Canada in the past 14 days?
YesNo
Have you been asked to self-isolate?
YesNo
Have you been in close contact with or had unprotected exposure to a confirmed or probable case of COVID-19?
YesNo
Have you had close contact with or had unprotected exposure to any person with an acute respiratory illness who has returned from travel outside of Canada with the past 14 days prior to their illness onset
YesNo
Do you have flu like symptoms, runny nose, cough, sore throat, diarrhea?
YesNo