COVID-19 SCREENING (South County Predators)

Print COVID-19 SCREENING
PLEASE INCLUDE THE NAMES OF EVERYONE THAT IS ATTENDING THE ICE TIME LISTED BELOW THAT RESIDE IN THE SAME HOUSEHOLD. IF YOU RESIDE IN DIFFERENT HOUSEHOLDS YOU MUST COMPLETE A SEPARATE FORM. SEPARATE FORMS WILL BE REQUIRED FOR EACH ICE TIME. THIS FORM MUST BE COMPLETED THE DAY OF THE EVENT. IF YOU ARE COMPLETING THIS FORM ON A MOBILE DEVICE YOU MAY NEED TO HOLD YOUR PHONE IN LANDSCAPE ORIENTATION TO VIEW PROPERLY.
CONTACT INFORMATION
Please include the names of everyone from the same household that is in attendance to the time and location listed below.
  1. Please list the full names of all those attending seperated by a comma
  2. Check All That Apply
  3. Example: ###-###-####
LOCATION & ICE TIME
COMPLETE THIS SECTION WITH REGARDS TO THE ICE TIME YOU WILL BE ATTENDING
COVID SCREENING QUESTIONS
These questions have been defined by the Ministry of Health and must be completed prior to entering the facility. This screening tool in not intended to take the place medical advice, diagnosis, treatment or legal advice.
  1. This can be because of an outbreak or contact tracing.
  2. If public health has advised you that you do not need to self-isolate (e.g. you are fully immunized* or have tested positive for COVID-19 in the last 90 days and since been celared), select "NO".
  3. If you have since tested negative on a lab-based PCR test, select "NO".
  4. 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". If you are fully vaccinated or have tested positive for COVID-19 in the last 90 days and since been cleared, select "NO".






  1. If you have answered NO to all of the questions you may enter the facility. 

    If you have answered YES to any questions DO NOT ATTEND!!

    Please go home to self-isolate immediately and contact your health care provider or Telehealth Ontario (1-866-797-0000) to get advice or an assessment.

    If any of the answers to these screening questions change during the day, this screening result is no longer valid, and you may need to screen again.

    * Fully immunized individual is defined as any individual >14 days after receiving their second dose of a two-dose COVID-19 vaccine series or their first dose of a one-dose COVID-19 vaccine series  (i.e. Johnson and Johnson).

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Printed from southcountypredators.com on Sunday, September 26, 2021 at 12:49 PM