Kawartha Lacrosse COVID-19 Screening
Anyone attending the fields/facility (whether they have been vaccinated or not) are required to complete a COVID-19 Daily Screening Form prior to entry.
If you answer yes to any of the screening questions, do not go to the field. Contact your coach or coordinator and follow Peterborough Public Health Guidelines on testing.
Personal information is collected under the authority of the Reopening Ontario (A Flexible Response to COVID-19) Act 2020, Ontario Regulation 364/20. The information will be used to screen for COVID-19 risk factors prior to attending the field.
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Please enter your name *
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I am a *
Have you experiences any new or worsening symptoms: fever, cough, runny or stuffy nose, sore throat, difficulty swallowing, shortness of breath, difficulty breathing, nausea, vomiting, diarrhea, loss of smell or taste, extreme tiredness or sore muscles? *
Is anyone you live with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms? If you are fully vaccinated (it has been 14 or more days since your final dose of either a two-dose or a one-dose vaccine series), select “No.” If the person got a COVID-19 vaccine in the last 48 hours and is experiencing a mild headache, fatigue, muscle aches, and/or joint pain that only began after vaccination, select “No.” *
Have you travelled outside of Canada in the past 14 days? If exempt from federal quarantine requirements (for example, you are fully vaccinated and have met the specific conditions, or an essential worker who crosses the Canada-US border regularly for work), select “No.” *
In the last 14 days, have you been identified as a “close contact” of someone who currently has COVID-19? If you are fully vaccinated (it has been 14 or more days since your final dose of either a two-dose or a one-dose vaccine series) and have not been told to self-isolate by public health, select “No.” *
Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)? *
In the last 10 days, have you tested positive on a rapid antigen test or home-based self-testing kit? If you have since tested negative on a lab-based PCR test, select "No."
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In the last 14 days, have you received a COVID Alert exposure notification on your cell phone? If you are fully vaccinated (it has been 14 or more days since your final dose of either a two-dose or a one-dose vaccine series), select “No.”If you already went for a test and got a negative result, select “No.” *
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