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COVID Screening Questionnaire
To be completed by anyone entering the property. For arena rentals and shows, all riders, trainers, and drivers must fill this form out the day before you are due to enter the property.
**Please note that anyone other than Rushmount riders and staff will not be permitted entrance in to the barn. Please bring ANY supplies you feel you may need (ie. pitch fork, shovel, water buckets, etc)**
Tell us a bit about yourself
Your Name
First
Last
Phone
###
-
###
-
####
Email
Your trainer's name
First
Last
Date of arrival at Rushmount
MM
/
DD
/
YYYY
Please enter the date you will be at Rushmount. If you are attending multiple days you will need to fill out a new form for each day.
Have you read our COVID info page?
Yes
No
Do you have a fever or chills?
Yes
No
Are you having difficulty breathing or shortness of breath?
Yes
No
Do you have a new or worsening cough?
Yes
No
Do you have a sore throat or difficulty swallowing?
Yes
No
Do you have a runny nose of any congestion unrelated to allergies or a pre-existing condition?
Yes
No
Are you experiencing any abdominal pain, vomiting, diarrhea, or nausea?
Yes
No
Are you experiencing any unexpected fatigue, lethargy, or sore muscles?
Yes
No
Have you travelled outside of Canada in the past 14 days?
Yes
No
Have you been in contact with a confirmed OR probable case of COVID 19?
Yes
No
Have you been advised by a health care provider to self-isolate?
Yes
No
If the answer to any of the above questions is yes please be advised that you will not be permitted on to the property. We ask that you self-isolate and fill out the Ontario COVID 19 self assessment at https://covid-19.ontario.ca/self-assessment/
I have not answered yes to any of the above questions
I have answered yes to one or more questions and am aware that I am not to enter Rushmount property
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