Nelson Paddling Club Daily Health Screening Checklist
Email *
Today's date *
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Full name of participant *
Is the participant experiencing any of the following symptoms? *
Required
Is the participant experiencing any of the following symptoms? *
Required
Is the participant experiencing cold, flu or COVID-19-like symptoms, even mild ones? Symptoms include: • Fever • Chills • Cough • Shortness of breath • COVID toes • Sore throat • Painful swallowing • Stuffy or runny nose • Loss of sense of smell • Kawasaki disease • Headache • Muscle aches • Fatigue * • Loss of appetite *Note: fatigue and muscle aches may be expected as individuals return to sport. Participants, and coaches must determine the difference between this and symptoms of illness. *
Has the participant or anyone in their household travelled to any countries outside Canada (including the United States) within the last 14 days? *
Has the participant or anyone in their household been in close contact with a person with a suspected or confirmed case of COVID-19 while they were ill (cough, fever, sneezing, or sore throat)? *
Has the participant tested positive for COVID-19 in the last 10 days? *
Emergency Phone# *Phone number of adult who completed this form *
Electronic Signature *By checking the box below, you are confirming that you are the adult named above, the answers provided are true and accurate and acknowledge that you are providing a legal electronic signature.
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