Title Page
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Conducted on
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Prepared by
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Location
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Scoring Information
Assessment Questions:
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What event or activity will you be attending?
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Approximately how many people will be in attendance at this event/activity?
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What is the length of time required for this activity or event?
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Is the activity or event located indoors or outdoors?
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What is the mode of transportation to and from this event or activity?
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Is it possible to maintain 6 feet of distance from others during this activity or event?
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Is the person you are supporting fully vaccinated?
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Does this individual live with others who are not fully vaccinated?
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Does the person you are supporting have any pre existing medical conditions (diabetes, asthma, etc)?
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Does this individual live with others who have pre-existing medical conditions?
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Does the activity or event provide a mental health benefit? (Reduces emotional distress, isolated feelings etc)
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Does the activity or event provide a physical health benefit? (Physical exercise such as walking or biking)
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Can the person you are supporting comply with mask wearing and PPE wearing requirements?
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Does the person you are supporting have behaviours that may prevent them from complying with PPE or distancing requirements? (close talking, hugging, aggression etc)
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Will there be access to hand washing or sanitizer stations?
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Does the event or activity have their own COVID protocols in place? (eg. mask wearing, screening upon entry etc)
