HomeLife Landmark Realty Inc. Covid-19 Questionnaire
HomeLife Landmark Realty Inc. is committed to continuous communication with our Partners, teams, agents, staff, clients and customers in light of the fast developing health crisis of Covid-19.
* Required
Before entering the premises, all workers and essential visitors must answer the following COVID-19 screening questions before signing in.
Name
*
Your answer
Phone Number
*
Your answer
Do you have any of the following new or worsening symptoms or signs? Symptoms should not be chronic or related to other known causes or conditions.
*
Yes
No
Fever or chills
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Yes
No
Difficulty breathing or shortness of breath
*
Yes
No
Cough
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Yes
No
Sore throat, trouble swallowing
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Yes
No
Runny nose/stuffy nose or nasal congestion
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Yes
No
Decrease or loss of smell or taste
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Yes
No
Nausea, vomiting, diarrhea, abdominal pain
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Yes
No
Not feeling well, extreme tiredness, sore muscles
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Yes
No
Have you travelled outside of Canada in the past 14 days?
*
Yes
No
Have you had close contact with a confirmed or probable case of COVID-19?
*
Yes
No
If you answered ‘No’ to all questions from 1 through 3, you have passed and can enter the workplace. Please affirm that you have completed your screening on the sign-in form before entering the premises, and adhere to physical distancing and masking requirements.If you answered ‘Yes’ to any of the questions from 1 through 3, you have not passed, and you should not enter the workplace. You should go home to self-isolate immediately and contact your health care provider or TelehealthOntario (1-866-797-0000) to find out if you need a COVID-19 test.
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