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 effective immediately no spectators will be permitted in our arenas (exception for 1 parent/guardian supervision of children (U15 teams and below)).

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 Attending *

Activity Start Time *

Attendees Role *

League *

COVID-19 SCREENING QUESTIONNAIRE

Please answer the following questions with YES or NO:

Are you currently experiencing any of the following symptom listed below? Answer YES to any that are new, worsening and not related to other known causes or conditions you already have.

For individuals who are 18 years of age and older	For individuals who are under 18 years of age
Fever and/or chills Cough or barking cough (croup) Shortness of breath Sore throat Difficulty swallowing Decrease or loss of smell or taste Pink eye Runny or stuffy/congested nose Headache Digestive issues like nausea, vomiting, diarrhea, stomach pain Muscle aches Extreme tiredness Falling down often	Fever and/or chills Cough or barking cough (croup) Shortness of breath Decrease or loss of smell or taste Sore throat or difficulty swallowing Runny or stuffy/congested nose Headache Nausea, vomiting and/or diarrhea Extreme tiredness or muscle aches

Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)?
In the last 14 days, have you been identified as a "close contact" of someone who currently has COVID-19?
In the last 14 days, have you received a COVID Alert exposure notification on your cell phone? If you already went for a test and got a negative result, select "NO".
In the last 14 days, have you travelled outside of Canada?
Is anyone you live with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms?

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 confirm that I have answered NO to all of the above 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.