Academy COVID-19 and General Health Daily Screening Form
Please provide the following information prior to each on-ice or off-ice session attended.
Last Name *
First Name *
Skating Season *
Role *
Skating Session - Date/Time *
Spectator Phone Number (only for spectators)
Skater's name the spectator is coming to watch? (only for spectators)
Location *
In the last 14 days, have you or a member of your household traveled outside Atlantic Canada? *
If yes, the participant is not permitted to attend HSC events for 14 days from the date of the return from out of Atlantic Canada.
In the last 14 days, have you had close contact (within 2 meters / 6 feet) with someone confirmed to have COVID-19? *
If yes, the participant is not permitted to HSC events for 14 days from the date the participant last had contact with the COVID-19 positive individual.
Required
In the past 48 hours have you had, or are you currently experiencing, any of these symptoms? *
If yes, the participant is not permitted to attend HSC events until symptoms have disappeared or a negative COVID-19 test is provided.
Yes
No
A fever (i.e. chills/sweats) OR Cough (new or worsening)
Two or more of the following symptoms (new or worsening) - Sore throat, Runny nose/nasal congestion, Headache, Shortness of Breath
Do you feel unwell today? *
If yes, the participant is not permitted to attend HSC session.
Required
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