COVID-19 Screening Form
Complete the following questionnaire prior to entering the facility. The questions are relevant to the player, volunteer and all members of the family "bubble'. You should refrain from entering the facility if you or any member of your family "bubble" are experiencing potential COVID-19 symptoms.

You should complete this form the day of practice or at least not more than 24 hours in advance.
Email address *
Player's Name *
Name of Parent or Guardian attending as a spectator (one only)
Age Group *
Association (input names below) *
Rink (input names below) *
Date of Practice or Game (Get this right , because we filter on this) *
MM
/
DD
/
YYYY
Time of practice/game (get this right too - AM/PM important) *
Time
:
COVID Symptoms
Answer the questions below related to you or anyone in your family (not including asymptomatic rotational workers).
Have you or anyone in your family (not including asymptomatic rotational workers); *
Yes
No
traveled in the last 14 days outside of Newfoundland and Labrador?
been in close contact with a known or suspected case of COVID -19 in the last 14 days?
been in close contact, in the last 14 days with a person suffering from accute respiratory illness who has travelled outside of the identified areas within 14 days prior to illness onset?
had 2 or more of the following symptoms (new or worsening) in the last 14 days: fever, cough, headache, sore throat, runny nose, painful swallowing, diarrhea, loss of sense of smell or taste, unexplained loss of appetite, or small red or purple spots on your hands and/or feet?
If you answered "YES" to any of the above, you are not permitted to enter the facility. If you answered "NO" to all the above, you can enter the facility when instructed to do so.
A copy of your responses will be emailed to the address you provided.
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