CN Curling Club COVID-19 Self Assessment Sign In

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Name *

Team Name (please indicate if you are a spare) *

Primary Phone Number *

COVID-19 Self Assessment

Are you experiencing any new or unexplained symptoms including:

Fever,
Cough,
Sore throat,
New muscle/joint pain,
Headache,
Chills, runny nose,
Loss of taste/smell,
Difficulty breathing,
Chest pain/pressure,
New confusion,
Loss of consciousness, or
Difficulty waking/staying awake?

Have you traveled outside Saskatchewan or Canada (including the United States) within the last 14 days?

Have you been exposed to someone under investigation for COVID-19, or who has tested positive for COVID-19 within the last 14 days?

Please answer yes or no based on the COVID-19 indicators above. *

Yes

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