Screening Checklist for Visitors and Players to the ROCKERS ATHLETIC CLUB

Screening Checklist for Visitors and Players to the ROCKERS ATHLETIC CLUB

Following questions will be asked of all individuals who wish to participate in ROCKERS ATHLETIC CLUB training activities.
Date

Month Day Year
Date
Name of the Participant
1. Have you washed your hands or used antiseptic prior to practice?

Yes No (please ask her/him to do)
2. Which of the following symptoms does the individual have?

Fever Cough Shortness of Breath Persistent Pain in the Chest No symptoms
❗You are not permitted to participate in practice or enter the clubhouse if you have any of the above symptoms or a fever!
3. Have you been following the government guidelines in respect to COVID-19 including Social Distancing?

Yes No
4. For players - check your temperature and enter the result.
5. Have you been in contact with people that were infected, suspected or diagnosed with COVID-19?

Yes No
6. Have you travelled anywhere internationally or out of province in the last 14 days? If so you MUST self-isolate for a minimum of 14 days and will not be allowed at training.

Yes No
7. Do you agree to follow the laws, recommended guidelines and protocols issued by the Government of Alberta and those of the Rockers Athletic Club and will adhere to these while participating in activities with the Rockers Athletic Club?

Yes No
❗You are not permitted to participate in practice or enter the clubhouse if you have been in contact with persons with symptoms or active COVID or if you have travelled outside of the province or country in the last 14 days!
Signature

Clear
Please ensure you:
- Wash your hands or use antiseptics before touching any equipment or entering the clubhouse.
- Not shake hands or be in physical contact during games or drills.
- Mask usage is optional if you wish to wear one during practice.
In the event that the Participant experiences any symptoms of illness such as a fever, cough, difficulty breathing, shortness of breath or malaise, immediately:
o Inform the Organization's COVID Safety Coordinator; and
o Immediately depart from the event or facility.
Should be Empty: