Your Name (Last Name, First Name)

Date of High-Performance Training

Have you received the COVID-19 vaccine?

Yes

No

Are you currently experiencing any of the following symptoms?

Fever (Temperature of 37.8 degrees Celsius or higher)

Chills

New or worsening cough

Shortness of breath or difficulty breathing (not related to another cause such as asthma)

Sore throat

Difficulty swallowing

Runny or stuffy nose (not related to another cause such as allergies)

Nausea, vomiting, diarrhea or stomach pain

Decrease or loss of taste or smell

Unexplained fatigue or muscle aches

Eye pain or pink eye

None of the above

Have you travelled outside of Canada in the last 14 days?

Yes

No

In the last 14 days, have you tested positive for COVID-19 or have you been in contact with any COVID-19 positive persons?

Yes

No

Daily Screening Form