Covid Screening (Campbellford Minor Hockey)

Print Covid Screening
Please complete the following screening procedure no earlier than the current day you are entering the arena, preferably 30 minutes before entry to allow time for submission. Questionnaire information will be stored in confidence by Municipality of Trent Hills staff and CMHA and are maintained for Contact Tracing Purposes should the Public Health Unit request it. This Health Screening Questionnaire has been developed based on the Ontario Ministry of Health Self Assessment Tool, Hockey Canada and the Ontario Hockey Federation.
Player Information
  1. If no one is entering with participant, please leave blank.
  2. If no one is entering with participant, please leave blank.
  3. Example: [email protected] Your submission will be sent to this address.
    1. In the last 5 days, have you tested positive on a rapid antigen test or PCR test?

    2. Are you currently experiencing one or more of these issues?
      • Severe difficulty breathing
      • Severe chest pain
      • Fever and/or chills
      • Cough or barking cough
      • Decrease of loss of smell
      • Muscles aches/joint pain
      • Extreme fatigue
      • Sore throat
      • Headache
      • Nausea, vomiting or diarrhea

    3. In the last 5 days, has someone you live with:
      • Been sick with symptoms associated with COVID-19?
      • Tested positive for COVID-19 (on rapid antigen test or PCR test)?

    4. In the last 5 days has you been identified as a 'close contact' of someone who has COVID-19?


    5. Have you travelled outside of Canada in the last 10 days and been instructed by Health Canada or your local health unit to isolate?
Human Validation