Orono Arena Health Screening Form - 2021-22 Season (Orono Amateur Athletic Association)

Print Orono Arena Health Screening Form - 2021-22 Season

This form must be filled out prior to entry to the Orono Arena. The form must be filled out by each person, everytime.

Arena Patron Information

Date of Visit^*

Time of Visit^*

Health Screening

Do you have a fever? ^*
YesNo
Feel hot to the touch, temperature above 38.8C
Do you have a new cough within the last two weeks?^*
YesNo
Do you have shortness of breath?^*
YesNo
Do you have a sore throat?^*
YesNo
Have you travelled outside Canada in the past 14 days or had close contact with anyone that has travelled outside of Canada in the past 14 days does not have a Government of Canada Travel Exemption?^*
YesNo
Have you had close contact in the past 14 days with anyone with active respiratory illness or an active confirmed or probable case of COVID-19 while not wearing PPE?^*
YesNo

PLEASE NOTE: This Health Screening questionnaire has been developed based on the current Ontario Ministry of Heath Self Assessment Tool. *For information on Travel Exemptions to the emergency order of the Government of Canada's Quarantine Act, please go to http://canada.ca/en/publichealth/services/diseases/2019-novel coronavirus-infection/latest-travel-health-advice.html#a3

Human Validation