As per AHS Guidelines & Return to Skating Protocol

This questionnaire must be completed by each individual prior to participation in EACH training session.  Checklist Information will be recorded and initialed by the individual responsible for tracking attendance on the Contact Tracing Log.  If an individual answers YES to any of the questions, they are not allowed to participate in the sport or activity. Children and youth will need a parent to assist them to complete this screening tool.

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* 1. Do you/your child have any new onset (or worsening) of any of the following 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 (unrelated to training), headache, or conjunctivitis (commonly known as pink eye)?

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

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

* “unprotected” means close contact without appropriate personal protective equipment
** “ill” means someone with COVID-19 symptoms on the list above

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* 4. Have you/your child attending the program or activity had close unprotected* contact (face to face contact within 2 metres/ 6 feet) in the last 14 days with someone who is ill**?

* “unprotected” means close contact without appropriate personal protective equipment
** “ill” means someone with COVID-19 symptoms on the list above

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* 5. Have you/your child or anyone in your household been in close, unprotected* contact in the last 14 days with someone who is being investigated or confirmed to be a case of COVID-19?

* “unprotected” means close contact without appropriate personal protective equipment

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* 6. Please enter your contact details below.  Enter your member type (Skater, Coach, PA, Parent, Executive, Volunteer) in the applicable box.

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