Trip Leaders / Instructors / Event Organizers: Please print out this questionnaire as part of your "day of" preparation. Keep the completed form for your records.
Participants: For the health and safety of club members, if you answer yes to any question, please do not facilitate or participate in this activity.
- Do you have a fever (>37.8°C or >100°F)?
- Do you have any cold/coronavirus symptoms: cough, sneezing, congestion, sore throat or difficulty swallowing?
- Are you having difficulty breathing or shortness of breath?
- Have you travelled outside the province of BC within the last 14 days? If yes, where?
- Have you been in contact with anyone who has travelled outside the province within the last 14 days?
- Have you been in contact with someone who has COVID-19 symptoms or has been quarantined within the last 14 days?
If during the trip, or after returning home and within 14 days, you develop symptoms of COVID-19 (and/or test positive for SARS-CoV-2) or have been advised to quarantine or seek medical attention please contact the leader of the activity so they may advise the other participants.
| By signing I confirm that I have answered "no" to the above questions regarding COVID-19. | ||
|---|---|---|
| Name: | Contact Phone: | Signature: |
| (Leader) | ||