Session Screening Checklist (under 18)

*This form will be updated to reflect any Government of Alberta and Alberta Health Services changes to questions and requirements.

Due to the Coronavirus (COVID-19) outbreak we are taking extra precautions with the care of every member to include session tracking, social distancing protocols and enhanced sanitation/disinfection procedures in accordance with the Alberta Heather Services. This form MUST be filled out EVERY SESSION. 

I understand/agree that by answering YES to question 1 the participant must quarantine for 14 days, if participant answers YES to question 2 participant must isolate for 10 days, and if participant answers Yes to questions 3 please follow the instructions given by AHS, this checklist MUST be completed every day before going to the gymnastics club throughout the above noted session.

1. Has the child: (Choose any/all possible exposures)

• Traveled outside Canada in the last 14 days? 
   YES  NO

When entering or returning to Alberta from outside Canada, individuals are legally required to quarantine for 14 days unless enrolled in the Alberta COVID-19 International Border Pilot Project.

• Had close contact with a case of COVID-19 in the last 14 days?
   YES  NO

Face-to-face contact within 2 meters for 15 minutes or longer, or direct physical contact such as hugging

If the child answered “YES” to any of the above:

• The child is required to quarantine for 14 days from the last day of exposure.
  • If the child is participating in the Alberta COVID-19 International Border Pilot Project, they must comply with the program restrictions at all times.
• If the child develops any symptoms, use the AHS Online Assessment Tool or call Health Link 811 to determine if testing isrecommended.

If the child answered “NO” to both of the above:

• Proceed to question 2.

2. Does the child have any new onset (or worsening) of the following core symptoms:

• Fever
   YES  NO

Temperature of 38 degrees Celsius or higher

• Cough
   YES  NO

Continuous, more than usual, not related to other known causes or conditions such as asthma

• Shortness of breath
   YES  NO

Continuous, out of breath, unable to breathe deeply, not related to other known causes or conditions such as asthma

• Loss of sense of smell or taste
   YES  NO

Not related to other known causes or conditions like allergies or neurological disorders 

If the child answered “YES” to any symptom in question 2:

• The child is to isolate for 10 days from onset ofsymptoms.
  • Use the AHS Online Assessment Tool or call Health Link 811 to arrange for testing andto receive additional information on isolation.

If the child answered “NO” to all of the symptoms in question 2:

• Proceed to question 3.

3. Does the child have any new onset (or worsening) of the following othersymptoms:

• Chills
   YES  NO

Without fever, not related to being outside in cold weather 

• Sore throat/painful swallowing
   YES  NO

Not related to other known causes/conditions, such as seasonal allergies or reflux

• Runny nose/congestion
   YES  NO

Not related to other known causes/conditions, such as seasonal allergies or being outside in cold weather

• Feeling unwell/fatigued
   YES  NO

Lack of energy, poor feeding in infants, not related to other known causes or conditions, such as depression, insomnia, thyroid dysfunction or sudden injury

• Nausea, vomiting and/or diarrhea
   YES  NO

Not related to other known causes or conditions, such as anxiety, medication or irritable bowel syndrome

• Unexplained loss of appetite
   YES  NO

Not related to other known causes or conditions, such as anxiety or medication

• Muscle/joint aches
   YES  NO

Not related to other known causes or conditions, such as arthritis or injury 

Headache
 YES  NO

Not related to other known causes or conditions, such as tension-type headaches or chronic migraines 

• Conjunctivitis 
   YES  NO

(commonly known as pink eye)

If the child answered “YES” to ONE symptom in question 3:

• Keep your child home and monitor for 24 hours.
• If their symptom is improving after 24 hours, they can return to school and activities when they feel well enough to go. Testing is not necessary.
• If the symptom does not improve or worsens after 24 hours (or if additional symptoms emerge), use the AHS Online Assessment Tool or call Health Link 811 to check if testing is recommended.

If the child answered “YES” to TWO OR MORE symptoms in question 3:

• Keep your child home.
• Use the AHS Online Assessment Tool or call Health Link 811 to determine if testing is recommended.
• Your child can return to school and activities once their symptoms go away as long as it has been at least 24 hours since their symptoms started.

If the child answered “NO” to all questions:

• Your child may attend school, child care and/or other activities

If the participant arrives exhibiting any of the above symptoms, staff has the right to refuse entry into the facility. If the participant develops any of the above symptoms, staff will implement their rapid response to symptomatic individuals’ policy.

I understand that coaches, employees, or volunteers cannot be held liable for any exposure to the COVID-19 virus caused by misinformation on this form or the health history provided by each participant.