COVID 19 Contact Tracing 2021/22 (Norwood Minor Hockey)

Print COVID 19 Contact Tracing 2021/22
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.
  1. Example: [email protected] Your submission will be sent to this address.
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SELF ASSESSMENT
Are you currently experiencing any one of the symptoms below that are NEW or WORSENING? Symptoms should not be chronic or related to other known causes or conditions





  1. Check any that apply
CRITICAL ASSESSMENT
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
  1. If you are fully immunized or have tested positive for COVID-19 in the last 90 days and since been cleared, select “NO"
  2. 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.”
SCREENING RESULTS
IF YOU ARE ABLE TO ANSWER "NO" TO ALL QUESTIONS YOU MAY ENTER IF YOU ANSWERED "YES" THEN YOU SHOULD NOT PARTICIPATE UNTIL YOU HAVE CONTACTED A HEALTH OFFICIAL OR YOUR HEATH CARE PROVIDER WE WOULD ALSO LIKE TO REMIND YOU THAT IF ANYONE IN YOUR HOUSEHOLD HAS BEEN ASKED BY THE HEALTH UNIT TO SELF ISOLATE/QUARANTINE THAT YOU NOT PARTICIPATE UNTIL THAT PERSON HAS A NEGATIVE RESULT.
  1. Check only the one that applies
  2. Check only if applies
Human Validation
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Printed from norwoodminorhockey.com on Monday, October 18, 2021 at 10:32 PM