2020 WTSC Covid-19 Protocols - Daily Health Screening Questionnaire
This questionnaire must be completed by each individual prior to participation in WTSC programs.

This questionnaire must be completed separately for each individual entering the facility on the date. You cannot complete this questionnaire in advance and a new questionnaire must be submitted daily.

The answer to all questions must be “No” in order to participate in each on-ice activity. If you have answered “Yes” to any of these questions, you are not permitted to participate in any on-ice activities and please do not come to the rink.

Please note: This Health Screening questionnaire has been developed based on the current Ontario Ministry of Health Self-Assessment Tool.



Email address *
Name *
Skater Name *
Date of Session *
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Emergency Contact Phone Number - Parents/Guardians are not allowed in the arena during skating sessions. Please enter a phone number that you can be reached at when your skater is participating in the session. *
Do you have a fever? (Feeling hot to the touch, a temperature of 37.8C or higher) *
Do you have the following symptom: Cough (continuous, more than usual) *
Do you have the following symptom: Shortness of breath *
Do you have the following symptom: Runny nose, sneezing or nasal congestion (not related to other known causes such as seasonal allergies etc.) *
Do you have the following symptom: A Sore throat *
Do you have the following symptom: Difficulty swallowing
Clear selection
Do you have the following symptom: Lost sense of taste or smell *
Have you travelled outside of Canada or had close contact with anyone that has travelled outside of Canada in the past 14 days without a Government of Canada Travel Exemption*? *
Have you had close contact in the past 14 days with anyone with a confirmed case of COVID-19, without the consistent and appropriate use of personal protective equipment? *
If you answered yes to any of the screening questions please do not come to the rink. Email office@wtsc.ca with your name, session date and time you will be missing. *For information on Travel Exemptions to the emergency order of the Government of Canada’s Quarantine Act, please go to: https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/latesttravel-health-advice.html#a3
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