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
Are you currently experiencing any of these symptoms? Choose any/all that are new, worsening, and not related to other known causes or conditions you already have.
Did you select any of the symptoms above? *
In the last 14 days, have you been identified as a “close contact” of someone who currently has COVID-19? *
In the last 14 days, have you received a COVID Alert exposure notification on your cell phone? YES/NO *
If you already went for a test and got a negative result, select “No.”
In the last 14 days, have you been in close physical contact with someone who is either currently sick with a new cough, fever, difficulty breathing, or other symptoms associated with COVID-19? (not related to getting a COVID-19 vaccine in the last 48 hours) OR returned from outside of Canada in the last 2 weeks *
Close physical contact means any of the following while not wearing the appropriate personal protective equipment (PPE): being less than 2 metres away in the same room, workspace, or area, living in the same home, and or being in the same classroom.
Have you travelled outside of Canada in the last 14 days? *
If exempt from federal quarantine requirements (for example, an essential worker who crosses the Canada-US border regularly for work), select “No.” If you are unsure please copy and paste this link in a new browser: https://travel.gc.ca/travel-covid/travel-restrictions/isolation#exemptions
Notice of Risk
Even if 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.
By attending the workshop below, you are attesting that you have not answered “Yes” to any of the questions above on the day of the workshop and that you acknowledge that Coaches Association of Ontario’s screening process cannot detect asymptomatic individuals. You agree to have the Coach Developer verbally confirm your attestation below. *