AFC COVID-19 Screening Form
Player Year of Birth
1. Are you currently experiencing any of these symptoms? Choose any/all that are new, worsening, and not related to other known causes or medical conditions.
Fever and/or chills
Difficulty breathing / shortness of breath
Decrease or loss of smell or taste
Sore throat or difficulty swallowing
Conjunctivitis or Pink Eye
Nausea, vomiting, and/or diarrhea
Headache that's unusual or long lasting
Runny or stuffy/congested nose (not related to other known causes suchas seasonal allergies, etc.)
None of the above
2. Have you travelled outside of Canada or had close contact with anyone that has travelled outside of Canada in the past 14 days?
4. In the past 14 days, has the public health unit identified you as a close contact of someone who currently has COVID-19?
5. Has a doctor, health care provider, or public health unit told them/you that they should currently be isolating (staying at home)?
Should be Empty: