Brant County Spectator Pre screen form (St. George Minor Hockey)

Print Brant County Spectator Pre screen form
This form has a limit of 800 submissions. At the moment this page loaded, 600 submissions have been submitted.
  1. I acknowledge that I will submit this screener no earlier than 12 Hours of each scheduled session, prior to arriving at the arena. 

    I acknowledge that I can submit this form up to 60 minutes to the participants scheduled ice time.

    I acknowledge that if I can't complete this questionairre in these time lines I will bring a completed form or retrieve paperwork at the screening table and complete the forms outside the arena. 
Parent/Guardian/Spectator
  1. Example: ###-###-####
  2. Example: [email protected] Your submission will be sent to this address.
  1. COVID -19 SCREENING CHECKLIST: Patron/ Participant

    The County of Brant is committed to providing a safe and healthy work environment for its employees, visitors and business associates. This checklist can be utilized for any participant entering any municipal facility as part of our response to slowing the spread of COVID-19. We appreciate your support in completing the screening of your participants.

    This checklist provides basic information only. It is not intended to take the place of medical advise, diagnosis or treatment
The answer to all questions must be "NO" in order to participate in any and all activity held at a County of Brant facility
You must answer all questions Yes or No
  1. For the remaining questions, close physical contact means

    1.Being less than 2 metres away in the same room, workplace or area over 15 minutes

    2. Living in the same home
Physical Contact
If an individual has answered "YES" to any questions, they are not permitted to participate in any activities at a County of Brant facility.
  1. Please note: This Health Screening questionnaire has been developed based on the Ontario Ministry of Health Self Assessment Tool located at
    https://covid-19.ontario.ca./self-assessment/
Human Validation
This form has a limit of 800 submissions. At the moment this page loaded, 600 submissions have been submitted.
Printed from stgeorgegenerals.ca on Tuesday, October 27, 2020 at 4:36 PM