CN Curling Club COVID-19 Self Assessment Sign In
Sign in to Google to save your progress. Learn more
Name *
Team Name (please indicate if you are a spare) *
Primary Phone Number *
COVID-19 Self Assessment
Are you experiencing any new or unexplained symptoms including:

Sore throat,
New muscle/joint pain,
Chills, runny nose,
Loss of taste/smell,
Difficulty breathing,
Chest pain/pressure,
New confusion,
Loss of consciousness, or
Difficulty waking/staying awake?

Have you traveled outside Saskatchewan or Canada (including the United States) within the last 14 days?

Have you been exposed to someone under investigation for COVID-19, or who has tested positive for COVID-19 within the last 14 days?

Please answer yes or no based on the COVID-19 indicators above. *
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy