TBVC Daily Health Screening Questionnaire
This questionnaire must be completed by each individual prior to participation in today's volleyball session. In order to participate in today's session the answer to all the questions must be "No"; except question 1.
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Your Name *
League/Team *
1. Have you tested positive for COVID-19 in the past 10 days or have you been told you should be isolating? *
2. Have you been in contact with a confirmed case of COVID-19? *
3. Have you traveled outside of Canada in the last 14 days and been told to quarantine (per the federal quarantine requirements)? *
4. Do you have a concern for a potential COVID-19 infection? (i.e. awaiting results) *
5. Do you have any of the following symptoms? (check all that apply) *
If an individual answers "yes" to any of these questions, they are not permitted to participate in today's session.

Please note: This Health Screening questionnaire has been developed based on the current Ontario Ministry of Health Self-Assessment Tool.
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