Self-Screening Questionnaire

IMPORTANT: This must be completed on the SAME DAY as your Workshop

Notice of risk

Even if the Coaches Association of Ontario has a screening process to help detect infections when there are symptoms, this screening process will not detect individuals who do not have any symptoms at the time of screening.

Self-Screening Questionnaire
In the last 5 days have you experiencing any of these symptoms? Choose any/all that are new, worsening, and not related to other known causes or conditions you already have. The symptoms listed here are the most commonly associated with COVID-19. Anyone who is sick or has any symptoms of illness, including those not listed below, should stay home and seek assessment from their health care provider if needed.
Have you selected any of the symptoms above? *
If you selected yes, complete the Government of Ontario’s Self Assessment for more information –
Do any of the following apply? You live with someone who is currently isolating because of a positive COVID-19 test, because of COVID-19 Symptoms, or is waiting for COVID-19 test results *
Select “No” if you are: 18 or older and have received your booster dose, or are 17 or younger and are full vaccinated, or completed your isolation after testing positive in the last 90 das (using a rapid antigen, rapid molecular, or PCR test)
In the last 5 days, have you tested positive on a rapid antigen test, molecular test, or home-based self-testing kit? *
Select “No” if you have already completed your isolation period of 5 days because your symptoms started before your positive test result, and: you do not have a fever, and your symptoms have been improving for 24 hours (48 hours for nausea, vomiting, and/or diarrhea)
Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)? *
This can be because of an outbreak or contact tracing.
In the last 14 days, have you travelled outside of Canada? *
If exempt from federal quarantine requirements as directed by the border agent at your point of entry (for example, you have two or more doses of a COVID-19 vaccine and have met the specific conditions, or an essential worker who crosses the Canada-US border regularly for work), select “No.”
By attending the workshop/event, you are attesting that you have not answered “Yes” to any of the additional questions above on the day of the workshop/visit and that you acknowledge that Coaches Association of Ontario’s screening process cannot detect asymptomatic individuals. You also agree to have the NCCP Coach Developer verbally confirm your attestation on site. *