1. SVC Daily COVID-19 Questionnaire (Stratford Volleyball Club)
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1. SVC Daily COVID-19 Questionnaire
The SVC Health Screening Questionnaire must be completed each day before you will be permitted to enter the Agriplex or training area, all of the following questions must be answered. If the answer to any question is yes, then entry is not permitted.
Player/Coach/Volenteer Information
First Name
*
Last Name:
*
Team
*
Select One...
11U Stingers
12U Stingers
13U Stingers
14U Stingers
15U Stingers
16U Stingers
17U Stingers
18U Stingers
14U Cobras
16U Cobras
18U Cobras
Executive/Volunteer
SVC Health Screening Questionnaire
Please answer the 4 questions below before each visit to the Agriplex.
Do you have any of the following symptoms: fever/feverish, new or worsening cough, difficulty breathing, runny nose or nasal congestion not related to allergies, sore throat, recent loss of taste or smell, pink eye, unusual headache, diarrhea, unexplained muscle aches, unexplained fatigue?
*
Yes
No
Have you traveled internationally (outside of Canada) within the last 14 days?
*
Yes
No
Have you had close contact with a confirmed or probable COVID-19 case in the last 14 days?
*
Yes
No
Have you had close contact with a person with acute respiratory illness who has been outside Canada in the last 14 days? Note: close contact means living in the same home, working in the same room, being less than 2 meters away in the same room.
*
Yes
No
If you have answered
NO
to all 4 questions you are permitted to enter the Agriplex at your scheduled time.
If you have answered
YES
to any of the 4 questions, you are not permitted to enter the Ariplex and you should contact your health care provider or be assessed at the Stratford COVID-19 assessment centre (519-272-8210 Ext. 2747) to get tested and/or further direction.
Human Validation
Check The Box
*
Human Validation Failed, Please Try Again
Team Sites
11U Stingers - Kara
12U Stingers - Lori
13U Stingers - Steve
13U Stingers -Ian
14U Cobras - Blair
14U Cobras - Camilo
14U Stingers - Ted
15U Stingers - Eric
16U Cobras - Bob
16U Stingers - Ken
17U Stingers - Shawn
18U Cobras - Spencer
18U Stingers - Greg
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Thu Jan 21, 2021
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Printed from stratfordvolleyballclub.com on Thursday, January 21, 2021 at 12:18 AM
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