DJHL COVID-19 Self-Assessment Form
Where required by a facility or home organization, complete the following questionnaire at least one hour prior to entering a facility to attend a DJHL activity. The completed form when submitted is retained electronically by the DJHL. The questions are relevant to the player, volunteer 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 to comply 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 DJHL for 14 days from the date completed and deleted thereafter.
Date of Session *
MM
/
DD
/
YYYY
Time of Session
Time
:
Email Address *
Player's Name *
Player's Team *
Name of parent/guardian accompanying player to DJHL session (if applicable) *
Location of Team Session *
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy