DLL COVID-19 HEALTH CHECK FORM
This form is required to be completed by volunteers who are not rostered on a team (coach or manager) but are volunteering as the Safety Person for a game or practice.
Select Location *
Date *
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Time *
Time
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First Name *
Last Name *
E-Mail *
Phone *
Are you sick with a cold/flu or are you displaying any signs of COVID-19 and/or flu-like symptoms? *
Do you have any of the following symptoms which are new or worsened if associated with allergies, chronic or pre-existing conditions: fever, cough, shortness of breath, difficulty breathing, sore throat, and/or runny nose? *
Have you travelled outside of the country within the last 14 days? *
Have you been identified by Public Health as a close contact of someone with COVID-19? *
Have you been told to isolate by Public Health in the last 14 days? *
If you answered "YES" to any of the above questions, have you been cleared by public health to resume normal activities? *
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