GameOn Sports COVID-19 Daily Assessment Tool
Senior Men's 4 On 4 Ball Hockey League 2020-2021 Season

Complete and submit the following Daily Assessment Questionnaire prior to entering the facility.

The questions are relevant to the player, and all members of the family "bubble'. You should refrain from entering the facility if you or any member of your family "bubble" are experiencing potential COVID-19 symptoms.

This information is being collected with your consent and in accordance with PIPEDA for the purpose of compliance with the directives of the Chief Medical Officer of Health of Newfoundland and Labrador in response to the COVID-19 Public Health Emergency.

By completing this form you consent to the collection, use and disclosure of this information as directed by the Chief Medical Officer of Health or as required by law. This information will be stored securely by GameOn Sports for 14 days from the date the form was completed, after which time it will be deleted.

Upon request, this data will also be made available to the NLBHA and the Northpoint Sports Facility.
Email *
Select Team *
Player's First and Last name: *
Player's Phone Number *
Do you have a fever and/or cough (new or worsening)? *
Do you have two or of the following symptoms (new or worsening)? *
Required
Have you been in close contact with a known or suspected case of COVID-19 (probably or confirmed) within the last 14 days? *
Have you or anyone in your household traveled outside Newfoundland and Labrador within the last 14 days? *
If you answered YES to any of the previous questions DO NOT PROCEED TO FACILITY. Remain at home and self-isolate. Visit gov.nl.ca/COVID-19 or call 811. If you responded NO to all questions, you may proceed to facility. *
Liability Waiver - check each box to acknowledge that you have read and understand each statement. *
Please check each box to acknowledge that you have read and understand each statement. If you do not understand each statement, please contact us at gameonsportsnl@hotmail.com
Required
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