Health Log
This needs to be filled out for 14 days prior to departure/travel and needs to be filled out every day until the season starts (so 14 days before you meet up to carpool from Ontario, every day of your trip and until you arrive in Camp)...For a lot of you, that means you need to start tracking now!
If there are days where you will not have access to wifi, please keep track of symptoms, temperature and interactions in your community and you can submit the form when you have access to wifi. Please make sure the dates are representative of the date of the record - not necessarily the date you filled out the form!
If you have questions...Planters, please reach out to your Foreman. Support/Cooks/Foremen please reach out to your Supervisor!
* Required
Date (this is the date of the record, not necessarily todays date).
*
MM
/
DD
/
YYYY
Full Name
*
Your answer
What crew are you on? (Management, select supervisor name)
*
Choose
Oliver Lonkay
Scott Caruso
Mackenzie Kirk
Emma Youell
Jacob Gillette
Liam Carroll
Grace Mackie
Andrew MacKinnon
Steve Dahl
Fran Smyth
Ben Stuart
Cory Scott
Nic Brown
Riley Tchida
Jackson Moores
Sarah Peacock
Camilla Daniels
Rob Wilson
Quincy Saunders-Scholes
Natalie Barry
Ryan Vanderlinden
Madeline Thiffault
Taylor Fenske
Kyle Ellsworth
Bryn Gabriel
Kathleen Fitzpatrick
Jonathan Brushett
Body Temperature
Your answer
Unit of Measurement used
Celcius
Farenheit
Clear selection
Time temperature was taken
Time
:
AM
PM
How did you take your temperature?
*
Oral thermometer
Ear thermometer
No-contact forehead thermometer
Underarm thermometer
Rectal thermometer
I don't have access to a thermometer today (but I will check the "Fever" box on the symptom page if I suspect I have a fever)
Other:
These symptoms have been associated with COVID-19, please check any and all boxes that represent what you experienced today.
*
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
Loss of consciousness
Fever
Cough
Sore throat
Runny nose
Headache
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
None of the Above
Required
If you checked any boxes above, please let us know when you started experiencing these symptoms and if you have noticed any changes in your symptoms?
Your answer
Please list any medications you have taken today for your symptoms (name, dosage, frequency).
Your answer
If you did not feel well, but none of the options listed above represent how you feel today, please use this space and give as many details as possible!
Your answer
Did you interact with your community today? Please write where you went and who you spent time with (ex. I went to the Save on Foods in Golden BC, and I crossed paths with a few people on a run and moved to maintain 2m spacing on the trail)
*
Your answer
If you are traveling, detail your route and all your stops
*
Your answer
To the best of your knowledge, did you interact with anyone that has either tested positive for COVID-19, or is presenting any of the symptoms listed above.
*
Yes
No
Other:
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
