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:
  1. filled out on the same calendar day as you will be in the building, and
  2. 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)


Location Attending *


Activity Start Time *


Attendees Role *


League *


COVID-19 SCREENING QUESTIONNAIRE

Please answer the following questions with YES or NO:
  1. Are you currently experiencing any of the following symptoms listed below? Answer YES to any that are new, worsening and not related to other known causes or conditions you already have.

    2. For individuals who are 18 years of age and olderFor individuals who are 17 years old and younger
    • Fever and/or chills Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or higher
    • Cough or barking cough (croup) Continuous, more than usual, making a whistling noise when breathing (not related to asthma, post-infectious reactive airways, COPD, or other known causes or conditions you already have)
    • Shortness of breath Out of breath, unable to breathe deeply (not related to asthma or other known causes or conditions you already have)
    • Decrease or loss of taste or smell Not related to seasonal allergies, neurological disorders, or other known causes or conditions you already have
    • Fatigue, lethargy, malaise and/or myalgias Unusual tiredness, lack of energy (not related to depression, insomnia, thyroid dysfunction, or other known causes or conditions you already have). If you received a COVID-19 vaccination in the last 48 hours and are experiencing mild fatigue that only began after vaccination, select "No."
    • Fever and/or chills Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or higher
    • Cough or barking cough (croup) Continuous, more than usual, making a whistling noise when breathing (not related to asthma, post-infectious reactive airways, COPD, or other known causes or conditions you already have)
    • Shortness of breath Out of breath, unable to breathe deeply (not related to asthma or other known causes or conditions you already have)
    • Decrease or loss of taste or smell Not related to seasonal allergies, neurological disorders, or other known causes or conditions you already have
    • Nausea, vomiting, and/or diarrhea Not related to irritable bowel syndrome, anxiety, menstrual cramps, or other known causes or conditions you already have

  2. In the last 14 days, have you travelled outside of Canada AND been advised to quarantine (as per the federal quarantine requirements)?
  3. Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)? NOTE: This can be because of an outbreak or contact tracing.
  4. In the last 10 days, have you been identified as a "close contact" of someone who currently has COVID-19? NOTE: If public health has advised you that you do not need to self-isolate (e.g., you are fully immunized* or have tested positive for COVID-19 in the last 90 days and since been cleared), select "No."
  5. In the last 10 days, have you received a COVID Alert exposure notification on your cell phone? NOTE: If you have already gone for a test and got a negative result, select "No." If you are fully immunized or have tested positive for COVID-19 in the last 90 days and since been cleared, select "No."
  6. In the last 10 days, have you tested positive on a rapid antigen test or a homebased self-testing kit? NOTE: If you have since tested negative on a lab-based PCR test, select "No."
  7. In the last 14 days, has someone in your household (someone you live with) travelled outside of Canada AND been advised to quarantine (as per the federal quarantine requirements) in the last 14 days? NOTE: If you are fully immunized or have tested positive for COVID-19 in the last 90 days and since been cleared, select "No."
  8. In the last 10 days, has someone in your household (someone you live with) been identified as a "close contact" of someone who currently has COVID-19 AND advised by a doctor, healthcare provider or public health unit to self-isolate in the last 10 days? NOTE: If you are fully immunized or have tested positive for COVID-19 in the last 90 days and since been cleared, select "No."
  9. Is anyone you live with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms? NOTE: If the individual experiencing symptoms received a COVID-19 vaccination in the last 48 hours and is experiencing mild fatigue, muscle aches, and/or joint pain that only began after vaccination, select "No." If you are fully vaccinated or have tested positive for COVID-19 in the last 90 days and since been cleared, select "No."
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.





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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.