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COVID-19: PARTICIPANT QUESTIONNAIRE AND ATTESTATION
I attest I am not experiencing any symptoms of illness such as a fever, cough, difficulty breathing, shortness of breath or malaise (severe fatigue or feeling of being generally unwell).
If I develop these symptoms, I agree that I will immediately inform the Event Staff and leave the premises.
I am aware that I must follow the safety and hygiene protocols of the Province of Alberta, the Public Health Agency and Run Calgary.
1. Does the attendee have any new onset (or worsening) of any of the following symptoms:
Check box if YES leave blank if NO
- Fever*
- Cough*
- Shortness of breath / difficulty breathing*
- Runny nose*
- Sore throat*
- Chills
- Painful swallowing
- Nasal congestion
- Feeling unwell / fatigued
- Nausea / vomiting / diarrhea
- Unexplained loss of appetite
- Loss of sense of taste or smell
- Muscle/ joint aches
- Headache
- Conjunctivitis (commonly known as pink eye)
2. Has attendee travelled outside of Canada in the last 14 days? YES / NO
3. Has attendee had close contact with a confirmed case of COVID-19 in the last 14 days? YES / NO
4. Has attendee had close contact with an individual who has any one of the first 5 symptoms on this list (with asterix*) AND who is a close contact of a confirmed case of COVID-19 in the last 14 days? YES / NO
I acknowledge and agree that I will follow recommended guidelines, laws and protocols of the Province of Alberta, the Public Health Agency and Run Calgary in order to reduce the spread of COVID-19.
I acknowledge that the foregoing statements are true.
_____________________________
Name of Participant (print)
______________________________ ____________________________________
Signature of Participant Date of Birth
