Pro Fit Boot Camp – Please fill out this form and give to Trainer at the start of every class
COVID-19 PRE-SELF ASSESSMENT QUESTIONNAIRE
This form must be completed ONLY within 4-12 HOURS in advance to your Pro Fit Boot Camp class. All questions below must be answered truthfully.
By completing this form, you are helping lower the risk for COVID transmission, keeping the gym, staff and other members safe from the spread of COVID-19. If you do not complete this form or answer YES to any of the questions, you will not be able to attend the scheduled classl
Thank you for your understanding.
Email address:
Name First and Last)
Date of Appointment:
COVID-19 Symptoms include: fever, chills, cough, and shortness of breath, sore throat and painful swallowing, stuffy or runny nose, loss of sense of smell, headache, muscle aches, fatigue and loss of appetite. People infected with COVID-19 may also experience gastrointestinal symptoms like diarrhea, nausea and vomiting a few days after the onset of the above symptoms.
- Are you currently experiencing any of the following:
Severe difficulty breathing (e.g. struggling to breathe or speaking in single words)?
Yes No
- Are you experiencing any of the following:
Mild to moderate shortness of breath
Inability to lie down because of difficulty breathing
Chronic health conditions that you are having difficulty managing because of difficulty breathing?
Yes No
- Are you experiencing cold, flu or COVID-19 liked symptoms, even mild ones?
Yes No
- Did you provide care or have close contact with a person with confirmed COVID-19?
Yes No
- Have you or anyone in your household been tested for COVID-19 and are waiting for results?
Yes No
- Have you traveled to any countries outside Canada (including the United States) within the last 14 days?
Yes No
Thank you for completing the self-screening questionnaire. If you answered yes to any of the above questions, please contact Pro Fit Boot Camp by phone or email to cancel your scheduled class.
Pro Fit Boot Camp
Hamid and Kelly
604 619 0232
