COVID-19 Questionnaire for Staff & Clients
We are screening all staff and clients for potential risk of COVID-19 on a daily basis. Please complete the following information when booking an onsite service appointment.
Email *
Name (First and Last) *
Date *
MM
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DD
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YYYY
Service Address: *
Required
I am a: *
Have you travelled outside of Canada in the last 14 days? *
Within the last 14 days have you tested positive for COVID-19 or had close contact with a confirmed case of COVID-19? *
Please click the boxes if you are experiencing any of the following symptoms. If you are not experiencing any symptoms, click None. *
Required
Additional Comments
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