Infectious symptoms assessment questionnaire
To be completed within 4 hours before coming to your training site
FR
*Warning! This form has been modified recently. Please read the questions attentively and answer accordingly.

Are you
First name*
Last name*
Sport*
Role*
Poste*
Phone to contact you*
Email*
Actually residing in*
Next training location attended*
Visit reason(s)*

Check the appropriate mention

1. Have you been completely vaccinated against COVID-19 (both doses for more than 14 days)? *
a. If so, date of 2nd dose.
b. Date 3rd dose, if applicable
c. Vaccine 3rd dose, if applicable
d. Date 4rd dose, if applicable
e. Vaccine 4rd dose, if applicable

2. Have you received a positive result for covid in the last 2 months?*
a. Date of test
b. Please link a photo of your test or proof of your result
 
3. Have you received a positive result for covid in the last 10 days?*
a. Date of test
b. Type of test
c. Please link a photo of your test or proof of your result

4. Do you have any of the following symptoms?*
a. Feeling feverish, shivering like if you had the flu OR a fever measured with a temperature taken by mouth of 38°C or higher.
b. Recent cough or cough that has recently worsened
c. Sudden lost of smell or taste without nasal congestion
d. Shortness of breath or trouble breathing
e. Intense and unusual fatigue without obvious reason
f. Unusual headache
g. Nausea, vomiting or diarrhea in the last 12 hours
h. Muscular pain or unusual aches (unrelated to physical effort)

5. Have you been in contact with a person who tested positive for Covid in the past 10 days?*
a. Date
 
6. Have you taken an antigenic test today?
a. Test results
b. Photo or proof of your AG test
 

In accordance with the health rules concerning COVID-19, you may not be authorized to enter your training site.

Any false declaration will result in expulsion from the training site for a period that may last until COVID-19 restrictions are completely lifted. The offending person will be prohibited from accessing the training site and using its facilities and services for the duration of the expulsion period.

In the event that I begin to present one of the above-mentioned symptoms while on the training site, I agree to immediately notify a manager at the site reception and I agree to be isolated in a room until I can call 1-877-644-4545 or leave the site safely.

This questionnaire is confidential. However, I accept that the Institut National du Sport du Québec and managers from the selected training site may communicate certain information collected to the competent authorities, if necessary.

I understand that these measures have been put in place to protect the health and safety of everyone. Zero risk does not exist and there is currently little scientific data on the risk of transmission in very high intensity sports activities involving athletes. Despite the health measures put in place, there remains a risk of contracting COVID-19 while training at the site.



I understand that these measures have been put in place to protect the health and safety of everyone.

I have read the instructions and guidelines for a safe return to work, I understand its contents and agree to comply with it.




Important reminder

Please inform us of all your interprovincial or international travels at least two weeks before your return to the INS Québec Complex. To transmit this information or for any other questions regarding COVID : testcovid@insquebec.org