Health Screening Survey
Please fill this Health Assessment before every class, camp or training at Deep Blue Athletics

Updated: June 9, 2020

If you have answer “YES” to any of the below questions do not participate. Proceed home and use the AHS Online Assessment Tool to determine if testing is recommended.
Email address *
Guardian Full Name: *
Participant Full Name *
Do you have current symptoms of COVID-19 such as:
Fever *
Normal temperatures in children are*:Mouth: 35.5-37.5°C (95.9-99.5°F)Underarm: 36.5-37.5°C (97.7-99.5°)Ear (not recommended in infants): 35.8-38.0°C (96.4-100.4°F) *According to the Canadian Pediatric Society Children often feel warm to the touch when they have a fever. To confirm that your child has a fever, use a thermometer to measure your child’s body temperature. If your child’s temperature is higher than normal, he/she has a fever.
Required
New or changed chronic cough *
Required
Sore throat that is not related to a known or pre-existing condition *
Required
A runny nose that is not related to a known or pre-existing condition *
Required
Chills
Painful Swallowing
Feeling Unwell / Fatigued *
Required
Nasal congestion that is not related to a known or pre-existing condition *
Required
Shortness of breath that is not related to a known or pre-existing condition *
Required
Nausea / Vomiting /Diarrhea
Clear selection
Unexplained Loss of Appetite
Clear selection
Loss of sense of smell or taste
Clear selection
Muscle or Joint Pain
Headache
Clear selection
Conjunctivitis
Clear selection
Have you, or anyone in your household, returned from travel outside of Canada in the last 14 days? *
Required
Have you or your children attending the program had close unprotected contact (face-to-face contact within two-metres) with someone who is ill with cough and/or fever? *
Have you had unprotected close contact with an individual who has a confirmed or presumptive diagnosis of COVID-19 (For example, individuals exposed without appropriate PPE in use?) *
Required
CONSENT *
Required
HAND WASHING *
Required
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