Return to Skating Health Screening
If an individual answers YES to any of the questions, they must not be allowed to participate in the sport or activity.

Children and youth will need a parent to assist them to complete this screening tool.
What arena are you skating right now *
FULL NAME: *
SCREENING CHECKLIST
If an individual answers YES to any of the questions, they must not be allowed to participate in the sport or activity.
Children and youth will need a parent to assist them to complete this screening tool.
1. Does the person attending the activity, have any of the below symptoms:
Fever *
Cough *
Shortness of Breath / Difficulty Breathing *
Sore throat *
Chills *
Painful swallowing *
Runny Nose / Nasal Congestion *
Muscle/joint aches (unrelated to training) *
Feeling unwell / Fatigued *
Nausea / Vomiting / Diarrhea *
Unexplained loss of appetite *
Loss of sense of taste or smell *
Headache *
Conjunctivitis (Pink Eye Symptoms) *
Have you, or anyone in your household, travelled outside of Canada and have or had any of the above symptoms in the last 14 days? *
Have you or your children attending the activity had close “unprotected” contact (face to face contact within 2 metres/6 ft) with someone who is ill with cough and/or fever? *
Have you or anyone in your household been in close unprotected contact in the last 14 days with someone who is being investigated or confirmed to be a case of COVID-19? *
If you have answered “YES” to any of the above questions do not participate. Proceed home and use the AHS OnlineAssessment Tool to determine if testing is recommended.
Street Address *
Postal code *
Email Address *
Phone Number *
Member Type *
Time in *
Time
:
Time out (5 minutes after your session ends) If you skate at two arenas at different times you must fill out two forms. *
Time
:
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