The COVID-19 Self Assessment Form is for your own purposes. Please check this form before every game, and if you are experiencing any of the symptoms, please do not enter the facility.

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Are you experiencing any of the following:

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- Severe difficulty breathing (e.g. struggling to breathe or speaking in single words)

- Severe chest pain

- Having a very hard time waking up

- Feeling confused

- Losing consciousness

- Mild to moderate shortness of breath

- Inability to lie down because of difficulty breathing

- Chronic health conditions that you are having difficulty managing because of difficulty breathing

- New or worsening cough

- Shortness of breath or difficulty breathing

- Temperature equal to or over 38C

- Feeling feverish

- Chills

- Fatigue or weakness

- Muscle or body aches

- New loss of smell or taste

- Headache

- Gastrointestinal symptoms (abdominal pain, diarrhea, vomiting)

- Feeling very unwell

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Have you travelled to any countries outside Canada (including the United States) within the last 14 days?

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Within the last 14 days did you provide care or have close contact with a symptomatic person known or suspected to have COVID-19?

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- A close contact is defined as a person who:

- Provided care for the individual, including healthcare workers, family members or other caregivers, or who had other similar close physical contact without consistent and appropriate use of personal protective equipment; or

- Lived with or otherwise had close prolonged contact (within 2 metres) with the person while they were infectious; or

- Had direct contact with infectious bodily fluids of the person (e.g. was coughed or sneezed on) while not wearing recommended personal protective equipment.

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Did you have close contact with a person who travelled outside of Canada in the last 14 days who has become ill (new or worsening cough; shortness of breath or difficulty breathing; temperature equal to or over 38C; feeling feverish; chills; fatigue or weakness; muscle or body aches; new loss of smell or taste; headache; gastrointestinal symptoms (abdominal pain, diarrhea, vomiting); feeling very unwell)?

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If you answered no to everything above, then your survey is complete and you are free to participate!