ISA Covid-19 Screening Checklist
Within 1 hour prior to each training session you will need to complete the following Screening Checklist for your child. The following information is collected to comply with Alberta's Return to Sport, Physical Activity and Recreation.

If an individual answers YES to any of the following questions, they may not participate. Go home and use the AHS Online Assessment Tool (https://myhealth.alberta.ca/journey/covid-19/Pages/COVID-Self-Assessment.aspx) to book an appointment. You are required to isolated!!

Information will be held for 6 weeks from the date of submission, after which time it will be removed from our secure database. Should you have any questions, please direct them to contact@internationalsocceracademy.ca

Overview:
This checklist applies for all children, as well as all students who attend kindergarten through Grade 12, including high school students over 18. Children should be screened every day by completing this checklist before going to school, child care of other activities. Children may need a parent or guardian to assist them to complete this screening tool.
Email *
What is your son/daughter's name? *
What is your name? *
Date of practice being attended *
MM
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DD
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Do you consent to providing the following information (which is being collected in compliance with Alberta's Return to Sport, Physical Activity and Recreation)? *
Program to which you are registered: *
Does the child have a fever? (38C or higher) *
Does the child have a cough? (continuous, more than usual, not related to other known causes or conditions such as asthma) *
Is the child Short of Breath? (continuous, out of breath, unable to breathe deeply, not related to other known causes or conditions such as asthma) *
Has the child lost sense of taste or smell? (Not related to other known causes or conditions like allergies or neurological disorders) *
Has the child Traveled outside Canada in the last 14 days? (When entering and returning to Alberta from outside Canada, individuals are legally required to quarantine for 14 days *
Has the child Has close contact with a case of COVID-19 in the last 14 days? (Face-to-face contact within 2 metres for 15 minutes or longer, or direct physical contact such as hugging) *
Does the child have chills? (without fever, not related to being outside in cold weather *
Does the child have a sore throat/painful swallowing? (Not related to other known causes/conditions, such as seasonal allergies or reflux *
Does the child have a Runny nose/congestion? (not related to other known causes/conditions, such as seasonal allergies or being outside in cold weather) *
Is the child feeling unwell/fatigued? (lack of energy, not related to other known causes or conditions, such as depressions, insomnia, thyroid dysfunction or sudden injury) *
Does the child have nausea, vomiting and/or diarrhea (not related to other known causes or conditions, such as anxiety, medication or irritable bowel syndrome *
Does the child have unexplained loss of appetite? (not related to other known causes or condition, such as anxiety or medication) *
Does the child have muscle/joint aches? (Not related to other known causes or conditions, such as arthritis or injury) *
Does the child have a headache? (not related to other known causes or conditions, such as tension-type headaches or chronic migraines) *
Does the child have Conjunctivitis (Pink Eye)?
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A copy of your responses will be emailed to the address you provided.
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