Welcome to Pro Teach Baseball

Proteach Daily Health Screening Questionnaire

This questionnaire must be completed by each individual prior to participation in each club activity. 

The answer to all questions must be “No” in order to participate in each club activity.

* Required

* Email Address:
* Today's Date:
* First and Last Name of Athlete:
* Do you have chills?:
Yes
No
* Do you have a fever? (Feeling hot to the touch, a temperature of 37.8C or higher)?:
Yes
No
* Do you have any of the following symptoms?:
Cough that's new or worsening(continuous, more than usual)
Barking Cough, making a whistling noise when breathing
Shortness of Breath (out of breath, unable to breath deeply)
Runny nose, sneezing (not related to seasonal allergies or other known causes or conditions)
Stuffy or congested nose (not related to seasonal allergies or other known causes or conditions)
Sore throat
Difficulty Swallowing
Lost sense of taste or smell
Pink eye
Headache that is unusual or long lasting
Digestive issues like nausea/vomiting, diarrhea, stomach pain (not related to other known causes or conditions)
Muscle aches that are unusual or long lasting
Extreme tiredness that is unusual (fatigue, lack of energy)
Falling down often
For young children and infants: sluggishness or lack of appetite
None of the above
* In the last 14 days, have you been in close physical contact with someone who tested positive for COVID-19? Close physical contact means: being less than 2 metres away in the same room, workspace, or area; living in the same home.:
Yes
No
* In the last 14 days, have you been in close physical contact with a person who is currently sick with a new cough, fever, or difficulty breathing?:
Yes
No
In the last 14 days, have you been in close physical contact with someone who returned from outside of Canada in the last 2 weeks? :
Yes
No
* Have you traveled outside of Canada in the last 14 days? (This does not include essential workers who cross the Canada-US border regularly):
Yes
No
If applicable, first and last name of anyone accompanying the athlete during the session. (driver, if staying):
If applicable, phone number of accompanying person.:
* First and Last Name of Parent/Guardian filling out this form on behalf of the athlete:
* Parent phone number:
Send me a copy of my responses

Summary

If an individual answers "yes" to any of these questions, they are not permitted to participate in any club activities. 

Please note: This Health Screening questionnaire has been developed based on the current Ontario Ministry of Health Self-Assessment Tool.