Session Screening Checklist (adult)

DISCLAIMER: By entering your name below you acknowledge that the information provided in this checklist is true and accurate.

Will be updated to reflect any Government of Alberta and Alberta Health Services changes to questions and requirements.
Alberta Gymnastics Federation | Last Updated: October 30, 2020

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 any of the following questions, on any given day throughout the above noted session, the participant noted above is required to remain home and will NOT be allowed to participate in any training sessions, camps, or any other activities.

1. Do you have any new onset (or worsening) of any of the following symptoms:

• Fever *
   YES  NO
   
• Cough *
   YES  NO
   
• Shortness of Breath / Difficulty Breathing *
   YES  NO
   
• Runny Nose *
   YES  NO
   
• Sore throat *
   YES  NO
   
• Chills
   YES  NO
   
• Painful swallowing
   YES  NO
   
• Nasal Congestion
   YES  NO
   
• Feeling unwell/Fatigued
   YES  NO
   
• Nausea/ Vomiting/ Diarrhea
   YES  NO
   
• Unexplained loss of appetite
   YES  NO
   
• Loss of sense of taste or smell
   YES  NO
   
• Muscle / Joint aches
   YES  NO
   
• Headache
   YES  NO
   
• Conjunctivitis (commonly known as pink eye)
   YES  NO

2. Has the attendee travelled outside of Canada in the last 14 days? 
  YES  NO

Individuals are legally required to quarantine for 14 days when entering or returning to Alberta from outside Canada unless exempted by the Alberta COVID-19 Boarder Testing Pilot Program.

3. Has the attendee had close contact¹ with a confirmed case of COVID-19 in the last 14 days? 
  YES  NO

¹ Face-to-face contact within 2 meters. A health care worker in an occupational setting wearing recommended personal protective equipment is not considered to be a close contact.

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.