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By peterboroughcricket | April 11, 2018

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2016

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Covid19 – Self Screening

Covid19 Self Screening

Please complete the questionnaire before the start of game. We needed these records for health & safety related purposes.

Appreciate your understanding.

Hello,

Could you provide your details

NameEmailPhone Number

Do you have any of the following symtoms

YES

Has a doctor, health care provider, or public health unit told you that you should
currently be isolating (staying at home)?

YES

In the last 14 days, have you travelled outside of province or Canada ?

YES

In the last 14 days, have you been identified as a “close contact” of someone who
currently has COVID-19?

YES

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