Swim Alberta Health Daily Checklist

SWIM ALBERTA HEALTH DAILY CHECKLIST

Name of Swimmer___________________________________.     Date______________________________

Attendees should fill out this checklist prior to participating in the activity or program.  If an individual answers YES to any of the questions, they must not be allowed to attend or participate in the activity or program.  Children and youth will need a parent to assist them to complete this screening tool.

As the COVID-19 pandemic continues to evolve, this screening tool will be updated as required.

1.

Does the attendee have any new onset (or worsening) of any of the following symptoms:

CIRCLE ONE

 

 

Fever

YES

NO

 

 

Cough

YES

NO

 

 

Shortness of Breath / Difficulty Breathing

YES

NO

 

 

Sore throat

YES

NO

 

 

Chills

YES

NO

 

 

Painful swallowing

YES

NO

 

 

Runny Nose / Nasal Congestion

YES

NO

 

 

Feeling unwell / Fatigued

YES

NO

 

 

Nausea / Vomiting / Diarrhea

YES

NO

 

 

Unexplained loss of appetite

YES

NO

 

 

Loss of sense of taste or smell

YES

NO

 

 

Muscle/ Joint aches

YES

NO

 

 

Headache

YES

NO

 

 

Conjunctivitis (commonly known as pink eye)

YES

NO

2.

Has the attendee travelled outside of Canada in the last 14 days?

YES

NO

3.

Has the attendee had close contact* with a confirmed case of COVID-19 in the last 14 days?

YES

NO

4.

Has the attendee had close contact with a symptomatic** close contact of a confirmed case of COVID-19 in the last 14 days?

YES

NO

* Face-to-face contact within 2 metres.  A health care worker in an 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.

               If you have answered “yes” to any of the above questions do not participate. Go home and use the AHS Online Assessment Tool to determine if testing is recommended.

Parents Signature_____________________________________________