Covid Self Assessment Form

1) Do you or your swimmer(s) have any of the following new or worsening symptoms or signs? (Symptoms should not be chronic or related to other know causes or conditions):
Fever or Chills

Difficulty breathing or shortness of breath


Sore throat/trouble swallowing

Runny nose/stuffy nose or nasal congestion

Decrease or loss of smell or taste

Nausea, vomiting, diarrhea, abdominal pain

Not feeling well, extreme tiredness, sore muscles

2) Have you or your swimmer(s) travelled outside of Canada in the past 14 Days?

3) Have you or your swimmer(s) had close contact with a confirmed or probable case of COVID–19?

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