COVID ENTRY FORM 2021-22 15 MINUTES BEFORE (Loyalist Township Minor Hockey)

Please complete the screening procedure no earlier than 15 minutes before entry. PLEASE ENTER FIRST AND LAST NAME OF ALL ENTRANTS! The form will automatically enter the time that the form is submitted so please follow this expectation. You will be asked by our volunteer at the door to confirm that the form is submitted and complete. The information collected will be stored by Loyalist Township Minor Hockey in a secure server for collection by the Public Health Unit if requested. Failure to complete this form may lead to exclusion from further LTMHA events.
  1. Example: ###-###-#### x###
  2. If no spectators enter none.
  3. If no spectators enter none.
  4. An answer of NO prohibits entry to facility.
  5. No other person other than the player and/or his/her companion who will enter the facility may complete this screening.

    This Health Screening Questionnaire has been developed based on the Ontario Ministry of Health Self Assessment Tool (June 17, 2020) and Hockey Canada and the Ontario Hockey Federation


    All completed Screening Questionnaires are held in complete confidence and are maintained for Contact Tracing Purposes should the KFLA Health Unit request it.

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Printed from on Monday, September 20, 2021 at 7:39 AM