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COVID-19 LMHA Attendance Screening
*** Please use TeamSnap's "Add Availability" feature to register all spectators and use Ontario's Self-Assessment screening tool ( https://covid-19.ontario.ca/self-assessment/ ) before completing this form.
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Email *
**** This Form is now deprecated in favour of TeamSnap's Health Check feature using the 'Add Availability' to capture all accompanying spectators.
Please refer to LMHA's COVID-19 How-To for complete details here: https://www.leitrimhockey.ca/covid-how-to/
Participant Type (select all that are attending) *
Required
Date of Session *
MM
/
DD
/
YYYY
Start Time of Session *
Time
:
Participant Name *
Attendee name(s)
Player Division *
Team/Activity *
Location *
I have completed and passed the Ontario COVID-19 self-assessment screening tool on behalf of the participant and any associated spectators.  https://covid-19.ontario.ca/self-assessment/ *
By agreeing, I acknowledge that all information provided above is accurate and I have agreed to follow the policies and procedures put in place by the City of Ottawa facilities upon entering the building. *
If you answered NO to the Ontario's self-assessment tool or the tool instructed you to self-isolate, please remain home and follow your public health authority guidelines for next steps. Visit OttawaPublicHealth.ca/Coronavirus for more information as you may be eligible for a COVID-19 test.
If feeling unwell, contact your health care provider or call Telehealth Ontario at 1-866-797-0000 to speak to a registered nurse.
A copy of your responses will be emailed to the address you provided.
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