Oshawa SC Daily Health Screening
* MUST be submitted each day of skating in order to participate.
* MUST be completed BEFORE arriving to the arena.
* MUST be completed by ALL skaters, parents/guardians, coaches and board volunteers entering the arena.
The answer to all questions must be NO in order to participate. If you answer YES to any of these questions, please DO NOT come to skating. Notify your coach if you are not attending a session.
Date of skating session
Name (first last)
How are you participating?
Parent/Guardian (in order to watch)
Do you have any of the following symptoms? Fever (feeling hot to the touch or temperature of 37.8C or higher), cough, shortness of breath, runny, stuffy or congested nose (not related to other known causes i.e. seasonal allergies, etc.), sore throat, difficulty swallowing, or lost sense of taste/smell
In the past 14 days...
The answer to all questions must be "NO" in order to participate.
Have you traveled outside of Canada or had close contact with anyone that has traveled outside of Canada and who does not have a Government of Canada Travel Exemption* ?
Have you had close contact, while not using PPE (personal protective equipment), with anyone who has an active respiratory illness or an active confirmed/probable case of COVID-19
Note: This Health Screening questionnaire has been provided by Skate Ontario and is based on the current Ontario Ministry of Health Self-Assessment Tool
* For information on Travel Exemptions to the Emergency Order of the Government of Canada's Quarantine Act, please visit:
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service