COVID-19 MINOR (Under 18) MEMBER SCREENING QUESTIONNAIRE
The safety of our Members and Employees is our top priority. In order to prevent the spread of COVID-19 and reduce the potential risk of exposure to our Membership, we are asking all Members to complete this questionnaire prior to arriving at the club.
Please ask yourself the following questions before arriving for the day.
Your participation is important to help us take precautionary measures to protect you and your fellow Members.
1. Are you currently experiencing any of the following symptoms?
▪ Fever (100.4 F/ 37.8 C or greater measured by an oral thermometer) - YES/NO
▪ Cough - YES/NO
▪ Shortness of breath or difficulty breathing - YES/NO
▪ Sore throat - YES/NO
▪ New loss of taste and/or smell - YES/NO
▪ Chills - YES/NO
▪ Head or muscle aches - YES/NO
▪ Nausea, diarrea, vomiting - YES/NO
2. In the past 14 days, have you been in close proximity to anyone who was experiencing any of the above symptoms since your contact with them? - YES/NO
3. In the past 14 days, have you been in close proximity to anyone who has tested positive for COVID-19? - YES/NO
4. Have you been tested for COVID-19 and are awaiting to receive your results? - YES/NO
5. Have you tested positive for COVID-19, or presumed positive for COVID-19 based on your health care providers assessment of your symptoms? - YES/NO
6. In the past 14 days, have you travelled outside Canada? - YES/NO
7. In the past 14 days, have you been in close proximity to anyone who has travelled outside Canada? - YES/NO
Members who answer yes to one or more of these questions are asked to complete the Ontario COVID Assessment prior to coming to the club,
PLEASE DO NOT COME TO THE CLUB IF YOU ANSWER YES TO ANY OF THE ABOVE QUESTIONS
COVID-19 MEMBER SCREENING NOVEMBER 2020