Innisfil Facility Check-in Form

This form must be filled out for EVERY PERSON entering an Innisfil Public Facility for any purpose and for any length of time. The form must be:

filled out on the same calendar day as you will be in the building, and
done before entering the facility.

For more information, please see the Town's Return to Play Protocol: Arenas.

PLEASE NOTE: EVERYONE must wear a face covering while in Town of Innisfil facilities (some exceptions apply - see the Town's Face Covering Policy CP.1.1.11 for more information)

First Name*

Last Name*

Phone (10 digits) *

Email (optional)

Please check if you are a minor below the age of 18

Location(s) Attending *

Activity Start Time *

Attendees Role *

League *

COVID-19 SCREENING QUESTIONNAIRE

Please verify that none of the following apply:

In the last 14 days, have you had close physical contact with someone who tested positive for COVID-19? This includes receiving a COVID Alert exposure notification. NOTE: "Close physical contact" means being less than 2 metres away in the same room, workspace, or area or living in the same home.
In the last 14 days, have you had close physical contact with someone who returned from outside of Canada in the last 2 weeks?
Have you travelled outside of Canada in the last 14 days?
Do you have any of the following symptoms: fever, new onset of cough, worsening chronic cough, shortness of breath, difficulty breathing, sore throat, difficulty swallowing, decrease or loss of sense of taste or smell, chills, headaches, unexplained fatigue/malaise/muscle aches (myalgias), nausea/vomiting, diarrhea, abdominal pain, pink eye (conjunctivitis), runny nose/nasal congestion without other known cause, and if you're over 70: delirium, unexplained or increased number of falls, acute functional decline, worsening of chronic conditions?

If you answered YES to ANY COVID-19 screening questions, you are NOT permitted to enter the facility. You should visit a COVID-19 Assessment Centre or contact your health care provider for follow up.

I agree that I have answered NO to all of the covid-screening questions and that to the best of my knowledge, myself and/or the minor on whose behalf I am signing, do not have COVID-19.

I have read and understood the above, and I confirm that my above answers are true to the best of my knowledge and ability. By clicking here, I understand that I am applying my digital signature.

(Please only click once and wait)

Personal Information collected through this page is collected, retained and disclosed in accordance with the Municipal Freedom of Information and Protection of Privacy Act for the purposes of Contact Tracing and Active Screening as required by provincial regulation and the advice of our public health officials. It may be disclosed to the Town, and/or public health officials in the event of an outbreak or suspected outbreak of COVID-19. It will be retained for 60 days, or longer in the event of an outbreak, suspected outbreak, or upon the advice and/or direction of the province or public health officials. For more information about this collection please contact The Town of Innisfil.