COVID-19 SELF CHECK (Brighton Minor Hockey)

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Print COVID-19 SELF CHECK
Please complete the following screening procedure no earlier than the current day you are entering the arena, preferably 30 minutes before entry to allow time for submission. When asked by our volunteer at the door to acknowledge that this SELF CHECK has been completed, please show them your submission confirmation that is emailed to you which will be date and time stamped. Questionnaire information will be stored in confidence by Municipality of Brighton staff and BDMHA and are maintained for Contact Tracing Purposes should the Public Health Unit request it. This Health Screening Questionnaire has been developed based on the Ontario Ministry of Health Self Assessment Tool (June 17, 2020), Hockey Canada and the Ontario Hockey Federation.
PLAYER INFORMATION
  2. If companion is not entering the arena, leave blank
  3. Example: ###-###-####
  4. Example: [email protected] Your submission will be sent to this address.
    1. Are you currently experiencing one or more of these issues?
      • Fever and/or chills (Feeling hot to the touch, a temperature of 37.8C or higher)
      • Cough that's new or worsening (continuous or more than usual)
      • Barking cough, making whistling noise when breathing (croup)
      • Shortness of breath, difficulty breathing, or chest pain (out of breath, unable to breathe deeply)
      • Sore throat (not related to seasonal allergies or other known causes or conditions)
      • Difficulty swallowing
      • Runny, stuffy or congested nose (not related to seasonal allergies or other known causes or conditions)
      • Lost sense of taste or smell
      • Pink eye (conjuctivitis)
      • Headache that’s unusual or long lasting
      • Digestive issues like nausea/vomiting, diarrhea, stomach pain (not related to other known causes or conditions)
      • Muscle aches
      • Extreme tiredness that is unusual(fatigue, lack of energy)
      • Falling down often
      • Feeling confused or unsure of where you are
      • Losing consciousness
      • For young children and infants: sluggishness or lack of appetite
    2. In the last 14 days, have you been in close physical contact with someone who tested positive for COVID-19? (This does not include essential workers who cross the Canada-US border regularly.)
    3. In the last 14 days, have you been in close physical contact with a person who either:
      • is currently sick with a new cough, fever, or difficulty breathing?) or;
      • returned from outside of Canada in the last 2 weeks?  (This does not include essential workers who cross the Canada-US border regularly.)
    4. Have you travelled outside of Canada in the last 14 days?
Human Validation