COVID-19 Screening (NDMS) (Norwood Minor Hockey)
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COVID-19 Screening (NDMS)
TO BE FILLED OUT WITHIN 2-6 HOURS PRIOR TO ARRIVAL AT THE ARENA. MUST BE COMPLETED FOR EVERY ON ICE SESSION - Practice or Game. Please read through the questionnaire and answer all of the questions. Please answer all questions accurately. Players who arrive at activities and appear to be symptomatic will not be allowed to participate. If your player is not feeling well, or showing any signs of any illness please keep them home. If you have any symptoms or answer yes you must stay home for a minimum of 24 hours after the last symptom subsides. You are given 2 options on the form: *PASS - answered "NO" to all questions and players are permitted to participate *FAIL- answered "YES" to any of the questions and players are NOT permitted to participate. Please notify Coach if your child is not attending and the reasons for missing, this is for tracking purposes. You will automatically get an email and will show this to the person filling out the tracking sheet
PLAYER IDENTIFICATION
1 FORM PER FAMILY Parent/Guardian - PLEASE LIST the individual who will be entering the arena with player.
Email Address
*
Example:
[email protected]
Your submission will be sent to this address.
Date
*
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Hornets Players Name
Adult/Guardian Entering Arena with Player
OTHER - Coach/Exec/ Referee/Timekeeper
Pick One
*
Select One...
Mites 1 - Spooner
Mites 2 - Watts
U7 - Clements
U7 - Rushlow
U7 - Matthews
U9 - Christie
U9 - C King
U9 Webb
U11 T1 - McMillan
U11 T2 - Hamblin
U13 T1 - Heffernan
U13 T1 - Harding
U13 T2 - Baptie
U13 T2 - Menard
U13 T2 - Seaboyer
U15 T1 - Beavis
U15 T2 - S King
U15 T2 - Mahoney
U18 - Smockum
Executive
Referee
U11 - T1 Post
U11 T2 - Poland
Timekeeper
Playing AWAY GAME - indicate which center/arena
HEALTH SCREENING Part 1
Do you have any ONE of the following symptoms?
Shortness of Breath
*
YES
NO
Decreased/Lost sense of taste or smell
*
YES
NO
Fever/Chills (37.8 or higher, feeling hot to the touch)
*
YES
NO
Cough that’s new or worsening (continuous, more than usual)
*
YES
NO
HEALTH SCREENING Part 2
Do you have any 2 or MORE of the following symptoms that is new OR persistent or worsening?
Sore Throat
*
YES
NO
Stuffy/Runny Nose
*
YES
NO
Headache
*
YES
NO
Nausea
*
YES
NO
Diarrhea
*
YES
NO
FAtigue, Lethargy, Muscle Aches or Malaise
*
YES
NO
Vomitting
*
YES
NO
If YES to any ONE primary or any 2 secondary symptoms - Have you had a negative COVID 19 swab and symptoms improving in the last 24 hours?
*
YES
NO
Not Applicable
CRITICAL ASSESSMENT
Answer ALL Questions For the remaining questions, close physical contact means: Being less than 2 metres away in the same room, workspace, or area for over 15 minutes Living in the same home
Have you been in close physical contact with someone who tested positive for COVID-19?
*
YES
NO
If YES, have you had 2 negative COVID 19 swabs at least 5 days apart?
*
YES
NO
Not Applicable
Have you had close physical contact with someone who has travelled outside Canada in the last 14 days? Close contact being less than 2 meters away in the same room/house?
*
YES
NO
If YES, are they exempt (as per health canada) from quarantine or has been 14 days passed and symptom free?
*
YES
NO
Not Applicable
Human Validation
Check The Box
*
Human Validation Failed, Please Try Again
Team Sites
Mites Group 1 (Spooner)
Mites Group 2 (Watts)
U7 - Team Clements
U7 - Team Rushlow
U7 - Team Matthews
U9 - Team Christie
U9 - Team C. King
U9 - Team Webb
U11 - Tier 1 Gold (McMillan)
U11 - Tier 1 Black (Post)
U11 - Tier 2 Black (Poland)
U11 - Tier 2 Gold (Hamblin)
U13 - Tier 1 - Black (Heffernan)
U13 - Tier 1 - Gold (Harding)
U13 - Tier 2 - Black (Baptie)
U13 - Tier 2 - White (Menard)
U13 - Tier 2 - Gold (Seaboyer)
U15 - Tier 1 (Beavis)
U15 - Tier 2 - Black (S. King)
U15 - Tier 2 - Gold (Mahoney)
U18 (Smockum)
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Mon Jan 25, 2021
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Printed from norwoodminorhockey.com on Monday, January 25, 2021 at 12:08 AM
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