2022 Level 1 Black - Covid Pre-Screen
NEW - January, 2022

This form is to be filled out prior to *each* practice. Failure to do so will mean your swimmer will not be permitted to attend practice.

Participants (athlete or coach) shall not attend the activity if they (or someone in their household):
● feels ill or experiencing any of signs or symptoms of COVID-19 (even mild ones)
● have tested positive with a Rapid Antigen test.
● are currently diagnosed with COVID-19, or are waiting to hear the results of a lab test for COVID-19
● have been notified that they may have been exposed to COVID-19 and must self-isolate based on Ontario health isolation protocols after exposure
● have been told by a doctor, health care provider, or public health unit to self-isolate
● do not pass self-screening
● do not pass the Swim Ontario COVID Attestation

Age Group Swimmers may use the Ontario Health School Screening guidelines before attending an activity.

Anyone who does not pass screening may not attend the activity and should follow provincial guidelines (self-isolate, call their health care provider or Telehealth Ontario). Further investigations may include a test for COVID-19. If home isolation is required, follow all Ontario Health Isolation Protocols. The participant may not return until they pass screening.
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Email *
Swimmer Name ( First, Last) *
Select the practice date *
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Do any of the following international travel scenarios apply to you?   In the last 14 days: you travelled outside of Canada and were told to quarantine, you travelled outside of Canada and told to not attend school/child care, someone you live with returned from outside Canada and is isolating while waiting for COVID-19 test results. If a child/student is not fully vaccinated but is exempt from federal quarantine because they travelled with a fully vaccinated companion, they must not go to school/child care for 14 days. Select “Yes” if this applies. No *
In the last 5 days, have you experienced any of these symptoms? Choose any/all that are new, worsening, and not related to other known causes or conditions you already have. Select “None of the above” if symptoms have been improving for 24 hours and you tested negative for COVID-19 on a single PCR test or two rapid antigen tests taken 24 to 48 hours apart. Anyone who is sick or has any symptoms of illness, including those not listed below, should stay home until their symptoms are improving for 24 hours and seek assessment from their health care provider if needed. *
In the last 5 days, have you tested positive for COVID-19?This includes a positive COVID-19 test result on a lab-based PCR test, rapid antigen test, or home-based self-testing kit. *
Do any of the following apply?   You live with someone who is currently isolating because of a positive COVID-19 test You live with someone who is currently isolating because of COVID-19 symptoms. You live with someone who is waiting for COVID-19 test results. Select “No” if the person has not tested positive for COVID-19 and only has one of these symptoms: sore throat or difficulty swallowing, runny or stuffy/congested nose, headache, extreme tiredness, muscle aches or joint pain, nausea, vomiting and/or diarrhea. *
Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)?This can be because of an outbreak or contact tracing. *
Have you been identified as a “close contact” of someone who currently has COVID-19 and been advised to self-isolate? If public health guidance provided to you has advised you that you do not need to self-isolate, select “No.” *
In the last 10 days, have you been identified as a “close contact” of someone who currently has COVID-19 (confirmed by a PCR or rapid antigen test)?  If public health has advised you that you do not need to self-isolate, select “No.” *
An athlete/coach/staff member must answer ‘No’ to all the above questions before participating in any in-person training session.If an athlete/coach/staff member answers ‘Yes’ to any of the above, the person cannot participate in the in-person training and they must contact their medical provider (doctor/nurse practitioner) and follow medical directions and cannot return to in-person training until cleared by the medical provider. * *
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Name of person filling out the form *
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