Castor Arena COVID-19 Screening Checklist

This form is to be completed by each individual entering the arena. If you have any symptoms or answer Yes to any of the questions, you are not to enter the arena.

Email address *

Date *

YYYY

First and Last Name *

Phone Number *

Place of Residence *

Do you have any new onset (or worsening) of any of the following symptoms? Individuals with fever, cough, shortness of breath, runny nose or sore throat, are required to isolate for 10 days. *

Fever*

Cough*

Shortness of Breath/Difficulty Breathing*

Runny Nose*

Sore Throat*

Chills

Painful Swallowing

Nasal Congestion

Feeling Unwell/Fatigued

Nausea/Vomiting/Diarrhea

Unexplained Loss of Appetite

Loss of Sense of Taste or Smell

Muscle/Joint Aches

Conjunctivitis (commonly known as pink eye)

No Symptoms

Required

Have you travelled outside Canada in the last 14 days? *

Yes

Have you had close contact with a case of COVID-19 in the last 14 days? *

Yes

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