Athlete Daily Screening Daily Screening [Sept 2021] "*" indicates required fields Daily Screening Checklist This checklist applies for all children, as well as all students who attend kindergarten through Grade 12, including high school students over 18. Children should be screened every day by completing this checklist before going to school, childcare or other activities. Children may need a parent or guardian to assist them to complete this screening tool.Athlete Name (First and Last)* Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Class Time* Wednesday 4:30pm Wednesday 6:00pm Thursday 3:30pm Friday 4:30pm Friday 6:45pm Team Program Sun/Tues/Thur Team Program Mon/Fri Drop In / Acro Jam Please select the start time of your classHiddenAthlete Age Emergency Contact Information Please provide contact information to supply to Alberta Health Services for contact tracing purposes in the event there are any reported COVID-19 illnesses that may affect your athlete or others they have been in contact with. This information may not be the same emergency contact we have on file.Emergency Contact Name* Emergency Contact Phone*Email* 1. Does the child have any new onset (or worsening) of the following core symptoms:Fever*Temperature of 38 degrees Celsius or higher Yes No Cough*Continuous, more than usual, not related to other known causes or conditions such as asthma Yes No Shortness of breath*Continuous, out of breath, unable to breathe deeply, not related to other known causes or conditions such as asthma Yes No Loss of sense of smell or taste*Not related to other known causes or conditions like allergies or neurological disorders Yes No You answered "Yes" to one of the above questions The child is to isolate for 10 days form onset of symptoms as per CMOH Order 39-2021 OR receive a negative COVID-19 test and feel better before returning to activities. - Use the AHS Online Assessment Tool or call Health Link 811 to determine if testing is recommended. Does the child have any new onset (or worsening) of the following other symptoms:Chills*Without fever, not related to being outside in cold weather Yes No Sore throat/painful swallowing*Not related to other known causes/conditions, such as seasonal allergies or reflux Yes No Runny nose/congestion*Not related to other known causes/conditions, such as seasonal allergies or being outside in cold weather Yes No Feeling unwell/fatigued*Lack of energy, poor feeding in infants, not related to other known causes or conditions, such as depression, insomnia, thyroid dysfunction or sudden injury Yes No Nausea, vomiting and/or diarrhea*Not related to other known causes or conditions, such as anxiety, medication or irritable bowel syndrome Yes No Unexplained loss of appetite*Not related to other known causes or conditions, such as anxiety or medication Yes No Muscle/joint aches*Not related to other known causes or conditions, such as arthritis or injury Yes No Headache*Not related to other known causes or conditions, such as tension-type headaches or chronic migraines Yes No Conjunctivitis (commonly known as pink eye)* Yes No If the child answered “YES” to ONE symptom in question 2: - 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.AHS Online Assessment Tool If the child answered “YES” to TWO OR MORE symptoms in question 2: - 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 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.Signature*Date EmailThis field is for validation purposes and should be left unchanged.