Covid Self Assessment Form House League (City of Vaughan Hockey)

Print Covid Self Assessment Form House League
THIS FORM MUST BE SUBMITTED BEFORE ALL HOUSE LEAGUE APPROVED TEAM ACITIVITIES.
PARTICIPANT INFORMATION
THIS IS PARTICPANT INFORMATION
  1. Example: ###-###-####
  2. Enter (NA) not applicable if you are over 18 and your are the participant
  3. Example: [email protected] Your submission will be sent to this address.
  1. Covid Symptoms

     

    The Screening must be done before each GTHL sanctioned activity including individual skills sessions, practices and games. 

    Are you currently experiencing any of these symptoms?



    Fever and/or chills -Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or higher

    Cough or barking cough (croup) - 
    Continuous, more than usual, making a whistling noise when breathing (not related to asthma, post-infectious reactive airways, COPD, or other known causes or conditions you already have


    Decrease or loss of taste or smell - 
    Not related to seasonal allergies, neurological disorders, or other known causes or conditions you already have

    Sore throat or difficulty swallowing - 
    Painful swallowing (not related to seasonal allergies, acid reflux, or other known causes or conditions you already have)


    Runny or stuffy/congested nose - 
    Not related to seasonal allergies, being outside in cold weather, or other known causes or conditions you already have.

    Pink eye (only applies to adults 18+) - 
    Conjunctivitis (not related to reoccurring styes or other known causes or conditions you already have

    Headache - 
    Unusual, long-lasting (not related to getting a COVID-19 vaccine in the last 48 hours, tension-type headaches, chronic migraines, or other known causes or conditions you already have)

    Extreme tiredness or muscle aches - 
    Unusual, fatigue, poor feeding in infants (not related to getting a COVID-19 vaccine in the last 48 hours, depression, insomnia, thyroid dysfunction, sudden injury, or other known causes or conditions you already have)

    Falling down often - 
    For older people


COVID QUESTIONS
If you have any of the symptoms above or answer YES to one or more of the questions below please self- isolate immediately and call your healthcare provider for further advice or assessment. A Team Participant is not allowed to participate in any hockey related activity or attend the facility unless cleared to do so by your healthcare provider or a COVID-19 Assessment Centre and you are symptom-free for 24 hours.
  1. If you are fully vaccinated (it has been 14 or more days since your final dose of either a two-dose or a one-dose vaccine series), select “No.” If the person got a COVID-19 vaccine in the last 48 hours and is experiencing a mild headache, fatigue, muscle aches, and/or joint pain that only began after vaccination, select “No
  2. If public health has advised you that you do not need to self- isolate (for example, you are fully vaccinated or for another reason), select “No.”
  3. If you are fully vaccinated, select “No”.
  4. This can be because of an outbreak or contact tracing
  5. If you have since tested negative on a lab-based PCR test, select "No."
  6. If you are fully vaccinated (it has been 14 or more days since your final dose of either a two-dose or a one-dose vaccine series), select “No.” If you already went for a test and got a negative result, select “No.”
  1. If you have any of the symptoms  above or answer YES to one or more of the questions above please self- isolate immediately and call your healthcare provider for further advice or assessment.
    A Team Participant is not allowed to participate in any hockey related activity or attend the facility unless cleared to do so by your healthcare provider or a COVID-19 Assessment Centre and you are symptom-free for 24 hours.

    Please review all your contact information.

    You will automatically receive a confirmation via email.  Please print a bring copy with you to tryouts.

    ALL ICE SESSIONS ARE  RESTRICTED TO PLAYERS AND TEAM OFFICIALS  WHO HAVE COMPLETED AND PASSED THE COVID ASSESSMENT FORM.

    ALL GOVERNMENT SAFETY COVID PROTOCOLS WILL BE IN PLACE FOR ALL ATTENDING TRYOUTS. 
    MASKS MUST BE WORN AND SOCIAL DISTANCING WILL BE REQUIRED.

    PARENTS WILL BE LIMITED TO 1 PER PLAYER.

Human Validation