2021-2022 Daily Covid 19 Questionnaire (Stratford Volleyball Club)

1a. Fever and/or chills: Temperature of 37.8 degrees celsius or hilgher and/or chills^*

YesNo

1b. Cough or barking cough (croup): Continuous, more that usual, making a whistling noise when breathing (not related to asthma, post-infectious reactive airways, or other known causes or conditions they already have)^*

YesNo

1c. Shortness of breath: Out of breath, unable to breathe deeply (not related to asthma or other known causes or conditions you already have^*

YesNo

1d. Decrease or loss of taste or smell: Not related to seasonal allergies, neurological disorders, or other known causes or conditions you already have.^*

YesNo

1e. Nausea, vomiting and/or diarrhea: Not related to irritable bowel syndrome, anxiety, menstral cramps, or other known causes or conditions you already have.^*

YesNo

2. Have you received your final (or second in a two-dose series) COVID-19 vaccination more than 14 days ago, or have they tested positive for COVID-19 in the last 90 days and have since been cleared?^*

YesNo

If you answer "yes" please proceed to #6, if "no" proceed to #3

3. Is someone that you live with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms? If the individual experiencing symptoms received a COVID-19 vaccination in the last 48 hours and is experiencing mild fatigue, muscle aches, and/or joint pain that only began after vaccination, select “No.

YesNo

4. In the last 10 days, have you been identified as a “close contact” of someone who currently has COVID-19? If public health has advised you that you do not need to self-isolate, select “No.”

YesNo

5. In the last 10 days, have you received a COVID Alert exposure notification on their cell phone? If they already went for a test and got a negative result, select “No.”

YesNo

6. In the last 14 days, have you travelled outside of Canada AND: • been advised to quarantine as per the federal quarantine requirements AND/OR •are you under the age of 12 and not fully vaccinated? If travel was solely due to a cross border custody arrangement, select “No.^*

YesNo

7. 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.^*

YesNo

8. In the last 10 days, have you tested positive on a rapid antigen test or a home-based self-testing kit? If you have since tested negative on a lab-based PCR test, select “No.”^*

YesNo

2021-2022 Daily Covid 19 Questionnaire (Stratford Volleyball Club)

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