COVID-19 Athlete Screening Questionnaire
Swim Alberta is requiring all member organizations track the attendance of all participants (swimmers, coaches, spectators, officials, volunteers) in any programming. On the program day and before the start of the event, you MUST answer the questions below to be eligible to participant.
If you have answered “yes” to any of the below questions DO NOT PARTICIPATE. Go home and use the AHS Online Assessment Tool to determine if testing is recommended.
*** IF A COVID TEST IS REQUIRED YOUR SWIMMER WILL BE UNABLE TO RETURN TO PRACTICE UNTIL IT IS ADVISED AS SAFE TO DO SO BY ALBERTA HEALTH SERVICES***
*** IF YOUR SWIMMER HAS ANY SYMPTOMS OF ILLNESS NOT RELATED TO COVID PLEASE KEEP THEM HOME UNTIL THEY ARE SYMPTOM FREE***
Parent / Guardian Phone Number
13 & O
12 & U
Mini Rays Schedule A
Mini Rays Schedule B
Learn to Swim
Date of Practice / Event
First and last names of all other attendees (if applicable)
I am aware of the Return to Swim Guidelines set out by Swim Alberta.
Do you or the participant have any new onset (or worsening) of any of the following symptoms: Fever, cough, shortness of breath, sore throat or, runny nose/nasal congestion, chills, painful swallowing, headache, muscle or joint aches, feeling unwell, fatigue or severe exhaustion, gastrointestinal symptoms such as nausea, vomiting, diarrhea or unexplained loss of appetite, loss of sense of smell or taste, or conjunctivitis (commonly known as pink eye)?
Has the participant or anyone in their household traveled outside of Canada within the last 14 days?
Has the participant or anyone in their household been in close unprotected contact* in the last 14 days with someone who is ill**, being investigated or a confirmed COVID-19 case?
* Face-to-face contact within 2 metres. A health care worker in a occupational setting wearing the recommended personal protective equipment is not considered to be a close contact.** ‘Ill/symptomatic’ means someone with COVID-19 symptoms on the list above.
A copy of your responses will be emailed to the address you provided.
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This form was created inside of Strathcona County Swim Club.