Climbers Corner Pre Screening Form
This must be filled out for every patron entering the facility prior to entry.
What is your name? (first & last) *
What is the date today? *
MM
/
DD
/
YYYY
Are you currently experiencing any of the following symptoms? *
Required
Was the participants temperature over 37.6C (99.7F) today? *
Does anyone in your household have any of the above mentioned symptoms? *
Have you recently been exposed to anyone who has tested positive for COVID-19? *
Has the participant travelled outside of Canada in the past 14 days? *
Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)? *
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