Officials Health Screening (EGMHA)

Print Officials Health Screening
Please complete this form prior to each time you enter the East Gwillimbury Sports Complex.
Official Information
Please provide your name and contact information.
  1. Enter the First and Last Name of person (player, coach, trainer) this form is being completed for (the person entering the building)
  2. Example: [email protected] Your submission will be sent to this address.
  3. Example: ###-###-####
Session Information
Please provide the date and time of your session.
  1. Please select the appropriate role.
  2. RadDatePicker
    Open the calendar popup.
    Enter the day on the ice
Are you currently experiencing any of these symptoms?
The answer to all questions must be “No” in order to participate in any and all activity.
  1. (Feeling hot to the touch, a temperature of 37.8C or higher)
  2. (continuous, more than usual)
  3. (croup)
  4. (out of breath, unable to breathe deeply)
  5. (not related to seasonal allergies or other known causes or conditions)
  6. (conjunctivitis)
  7. (fatigue, lack of energy)
Physical Contact Information
For the remaining questions, close physical contact means: Being less than 2 metres away in the same room, workspace, or area for over 15 minutes or living in the same home.
  1. If you have answered “Yes” to any of these questions, the player/coach is not permitted to participate in the on-ice session.
Human Validation
Printed from on Wednesday, January 20, 2021 at 8:18 AM