Daily COVID-19 Screening Tool
This questionnaire must be completed by each individual prior to participation in each SMSC on-ice or off-ice activity. This includes participation in sessions on rented ice outside of SMSC setting.
Skater's Name *
Today's date *
Screening Questions
1. Is the skater currently experiencing any of these symptoms? The symptoms listed here are the symptoms most commonly associated with COVID-19. Our guidelines for children and adults continue to evolve as we learn more about COVID-19, how it spreads, and how it affects people in different ways. Choose any/all that are new, worsening, and not related to other known causes or conditions they already have.
Fever and/or chills. Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or higher and/or chills
Clear selection
Cough or barking cough (croup). Continuous, more than usual, making a whistling noise when breathing (not related to asthma, post-infectious reactive airways, or other known causes or conditions they already have)
Clear selection
Shortness of breath. Out of breath, unable to breathe deeply (not related to asthma or other known causes or conditions they already have)
Clear selection
Decrease or loss of taste or smell. Not related to seasonal allergies, neurological disorders, or other known causes or conditions they already have
Clear selection
Nausea, vomiting and/or diarrhea. Not related to irritable bowel syndrome, anxiety, menstrual cramps, or other known causes or conditions they already have
Clear selection
2. Did the skater receive their final (or second in a two-dose series) COVID-19 vaccination dose more than 14 days ago, or have they tested positive for COVID-19 in the last 90 days and have since been cleared? If YES, answer questions 3, 4 and 5 with N/A. *
3. Is someone that the skater lives with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms? If the individual experiencing symptoms received a COVID-19 vaccination in the last 48 hours and is experiencing mild fatigue, muscle aches, and/or joint pain that only began after vaccination, select “No.” *
4. In the last 10 days, has the skater been identified as a “close contact” of someone who currently has COVID-19? If public health has advised you that you do not need to self-isolate, select “No.” *
5. In the last 10 days, has the skater received a COVID Alert exposure notification on their cell phone? If they already went for a test and got a negative result, select “No.” *
6. In the last 14 days, has the skater travelled outside of Canada AND has been advised to quarantine as per the federal quarantine requirements AND/OR is the skater under the age of 12 and not fully vaccinated? If travel was solely due to a cross border custody arrangement, select “No.” *
7. Has a doctor, health care provider, or public health unit told you that the skater should currently be isolating (staying at home)? This can be because of an outbreak or contact tracing. *
8. In the last 10 days, has the skater tested positive on a rapid antigen test or a home-based self-testing kit? If the skater has since tested negative on a lab-based PCR test, select “No.” *
Results of screening questions
If you answered “YES” to any of the symptoms included under question 1, do not go to the rink.
If you answered “YES” to questions 3, 4, 5, 6, 7 or 8, do not go to the rink.
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