Daily Practice COVID-19 Screening Checklist
Penguin Swimming Parents and Penguin Masters Swimmers are required to complete this checklist PRIOR to EVERY practice. Swimmers will not be able to participate in practice if the checklist has not been completed PRIOR to EVERY practice.

If YES is answered to ANY question, swimmers must NOT ATTEND practice, and should refer to AHS Online Assessment Tool to determine if testing is recommended.
Email address *
Swimmer's LAST Name *
Swimmer's FIRST Name(s) *
Todays' Date (practice date) *
MM
/
DD
/
YYYY
Swim Program *
Does your swimmer (or you as a Masters swimmer) have any new onset (or worsening) of any of the following signs or symptoms: *
YES
NO
Fever - Chills - Cough
Shortness of Breath - Difficulty Breathing
Painful Swallowing - Sore Throat
Nasal Congestion - Runny Nose
Feeling Unwell - Fatigued
Nausea - Vomiting - Diarrhea
Unexplained Loss of Appetite
Loss of Sense of Taste or Smell
Muscle / Joint Aches
Headache
Conjunctivitis (Pink Eye)
Has your swimmer (or you as a Masters swimmer) travelled outside of Canada in the last 14 days? *
Has your swimmer (or your as a Masters swimmer) had close contact* with a confirmed case of COVID-19 in the last 14 days? *
* Face-to-face contact within 2m. Health care workers in an occupational setting wearing the recommended PPE is not considered to be close contact.
Has your swimmer (or you as a Masters swimmer) had close contact* with a symptomatic** case of COVID-19 in the last 14 days? *
* Face-to-face contact within 2m. A health care worker in a occupational setting wearing the recommended PPE is not considered to be close contact. ** Symptomatic means someone with COVID-19 symptoms on the list above.
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