Required fields are marked with asterisks (*)

Recreation Facilities COVID-19 Screening Tool

Note: This tool must be filled out on the day of your event.

Please complete all questions and submit your results. Once submitted, an email will be sent to the email address provided in the tool below. Proof of completing this tool must be shown prior to entering the recreation facility. Thank you for your co-operation.

For contact tracing purposes, please enter your arrival and departure times for your event today as accurately as possible.

** Fully vaccinated means - it has been 14 or more days since your final dose of either a two-dose or a one-dose vaccine series **

Are you currently experiencing one or more of the following symptoms that are new or worsening?
Symptoms should not be chronic or related to other known causes or conditions.

  • Fever and/or chills (temperature of 37.8 degrees Celsius/100 degress Fahrenheit or higher)
  • Cough or barking cough (not related to asthma, post-infectious reactive airways, COPD, or other known causes or conditions you already have)
  • Shortness of breath (not related to asthma or other known causes or conditions you already have)
  • Decrease or loss of smell or taste (not related to seasonal allergies, neurological disorders, or other known causes or conditions you already have)
  • For Adults 18 years or older:Fatigue, lethargy, malaise and/or myalgias (unusual tiredness, lack of energy; not related to depression, insomnia, thyroid dysfunction, or other known causes or conditions you already have

*If you received a COVID-19 vaccination in the last 48 hours and are experiencing a mild headache that only began after vaccination, select “No”.

Have you travelled outside of Canada in the last 14 days AND been advised to quarantine per the federal quarantine requirements?

In the last 14 days, has someone in your household (someone you live with) travelled outside of Canada AND been advised to quarantine per the federal quarantine requirements?

If you are fully vaccinated or have tested positive for COVID-19 in the last 90 days and since been cleared, select “No.”

In the last 10 days, has someone in your household (someone you live with) been identified as a “close contact” of someone who currently has COVID-19 AND advised by a doctor, healthcare provider or public health unit to self isolate?

If you are fully vaccinated or have tested positive for COVID-19 in the last 90 days and since been cleared, select “No.”

Is anyone you live with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms?
If you are fully vaccinated, or have tested positive for COVID-19 in the last 90 days and since been cleared, select “No.”
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”.

In the last 10 days, have you been identified as a “close contact” of someone who currently has COVID-19?
If public health has advised you that you do not need to self-isolate (e.g. you are fully vaccinated or have tested positive for COVID-19 in the last 90 days and since been cleared) select “No”.

In the last 10 days, have you received a COVID Alert exposure notification on your cell phone?
If you are fully vaccinated and/or have already gone for a test and got a negative result, select “No”.

Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)?
This can be because of an outbreak or contact tracing.

In the last 10 days, have you tested positive on a rapid antigen test or a home based self-testing kit?
If you have since tested negative on a lab-based PCR test, select “No”.

Acknowledgements:

I understand that if I do not pass this screening tool I am not to enter the facility.

I understand that if I become ill or develop symptoms while in the facility, I should leave the facility immediately, self-isolate and contact Public Health for information regarding COVID-19 testing.

Any collection of personal information is made under the authority of the Ministry of Health COVID-19 Guidance for facilities for sports and recreational fitness activities during COVID-19. Personal information is collected in compliance with the Municipal Freedom of Information and Protection of Privacy Act.

Personal information is collected for the purpose of complying with provincial orders related to the COVID-19 pandemic.  None of your personal information will be shared, rented, sold or otherwise released to any third party without your consent. 

Any questions about this collection should be directed to: 625-2351.



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