Daily Health Questionnaire Thorold Skating Club
Please fill this out on the day of your sessions to speed up building admissions. Thank you .Happy Skating * This questionnaire has been copied from Skate Ontario's Health Questionnaire , it has been developed based on the current Ontario Ministry of Health Self-Assessment tool.
Name of Skater( First and last ) *
Do you have a fever ? *
Do you have a new or worsening cough? *
Do you have shortness of Breath? *
Do you have a runny nose or congested nose ( not related to know causes such as allergies?) *
Do you have a sore throat? *
Difficulty swallowing ? *
Lost of sense of taste and smell?
Clear selection
Have you travelled outside of Canada in the past 14 days? or had close contact with anymore that has travelled outside of Canada in the past 14 days that does not have a Government Travel Exemption? *
Have you had close contact within the past 14 days with anyone with active respiratory illness or an active confirmed or probable case of COVID-19, without consistent and appropriate use of protective equipment? *
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy