BPYC Covid-19 Screening Form

This screening form needs to be completed EACH TIME a person visits the club property.
* Required

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* 1. Name

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* 2. Provide your phone number or email so we can contact you

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* 3. Date and time on the site

Date
Time

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* 4. Are you experiencing any of the following symptoms

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* 5. Has a doctor, health care provider or public health unit told you that you should currently be isolating (staying at home)? 

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* 6. In the last 14 days, have you been identified as a "close contact" of someone who currently has Covid-19? (If you were wearing full PPE including N95 select "No") *

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* 7. In the last 14 days, have you or anyone you live with travelled outside of Canada? 

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* 8. Is anyone you live with currently experiencing any new Covid-19 symptoms and/or waiting for test results after experiencing symptoms? *

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* 9. I have answered the above questions honestly to the best of my knowledge and agree to follow the covid-19 safety policies and procedures while on site including: maintaining physical distancing; mask wearing outdoors where 2m physical distancing cannot be maintained; mask wearing indoors*

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* 10. Did you answer "yes" to any of the above questions?
If you answer "yes" to questions 4-8 above, you are not to visit the club property. Quarantine and contact telehealth if you have not already done so. Telehealth 1 866-797-0000

Also, follow BPYC reporting procedures by reporting any covid symptoms or confirmed covid cases to Commodore, if you have been on the property within the last 14 days.
Reporting officer: Commodore, Linda Dudas
Email: commodore@bpyc.on.ca 
Phone: 416-267-7245

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