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 AHSOnline Assessment Tool to determine if testing is recommended.
