Covid 19 Activity Screening Questions
Complete the following form
no more than 12 hours before
any Scouting Activity that you or your youth wish to attend. This is required to keep track of participants health prior to the activity. One form per participant. If this form is not completed before the activity, then the pariticant will not be allowed to participate until it is filled out and successfully submited.
All fields are required
Date of the Event:
Name of Participant:
Please provide name and Phone number of contact which can be reached during the activity.
Parents or Emergency Contacts must be available at all times during the activity. They are not permitted to stay, unless they are participating. To participate, they must have signed the "Code of Conduct", and follow all rules for COVID, they will be limited to 5 visits, otherwise they must sign up to become a volunteer.
Name of Emergency Contact:
Note: questions have been updated
Please answer all of the following questions.
Symptoms of COVID-19 can include:
1. Difficulty swallowing
2. Sore throat
3. New olfactory or taste disorder(s)
4. Nausea/vomiting, diarrhea, abdominal pain.
5. Runny nose, or nasal congestion.
6. Chills, night sweats.
If you answered "YES" to any of the questions, do not come to the activities, and seek medical evaluation.
Fever (Temperature of 37.8C/100F or greater)?
New or worsening cough?
Shortness of breath (dyspnea)?
If double Vaccinated: Have you, or anyone in your household, returned from travel outside of Canada in the last 5 days?
If NOT - double Vaccinated: Have you, or anyone in your household, returned from travel outside of Canada in the last 10 days?
If double Vaccinated: Have you had a positive test or been symptomatic (as outlined above) in the last 5 days?
If NOT - double Vaccinated: Have you had a positive test or been symptomatic (as outlined above) in the last 10 days?
*It is understood that some allergies or pre-existing conditions may express similar symptoms to COVID-19. If in doubt consult a medical professional. Please discuss participation with your Section Contact Scouter or Group Commissioner before attending Scouting. If in doubt don't Scout.
** "Unshielded". means close contact (with two metres) without the use of appropriate personal protective equipment (PPE)
Copyright © 2022 Philippe Faure
Last modified: August 12, 2022
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