COVID-19 SELF ASSESSMENT

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.

Are you experiencing any of the following:

- 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

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

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

- 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.

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)?

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

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