Self-Declaration Form for Visitors to all CENTRIX Locations in BC
The health and safety of our customers, partners, and employees is and always will be a core value of our business, and we continue to take the necessary steps to ensure we are doing our part to keep the community healthy.

In response to COVID-19, and in compliance with the Provincial Health Officer's order, all visitors must complete this Self-Declaration Form prior to entering any CENTRIX facility. This screening process will be required of any workers or essential visitors entering CENTRIX workplaces.

Effective immediately: To protect you and our employees, a face mask/covering is required while indoors and anywhere physical distancing cannot be maintained (6’ or 2 meters).

Learn more:
Email address *
Are you experiencing any of the following new-onset symptoms - Fever or chills; new or worsening cough; stuffy or runny nose; sore throat/trouble swallowing; diarrhea; difficulty breathing; nausea and/or vomiting; fatigue; muscle aches; loss of appetite; chills; headache; loss of sense of smell? *
Have you travelled outside of Canada, including the United States, within the past 14 days? *
Have you been in close contact with someone who has a confirmed COVID-19 diagnosis within the last 14 days? *
Have you been told to self-isolate in accordance with Public Health Directives? *
Applicable visitors must ensure that this form is completed in full and submitted to the CENTRIX contact person prior to each scheduled entry at any CENTRIX location. If a visitor answers “NO” to the above questions, they will be authorized access to the worksite. If a visitor answers “YES” to any of the above questions, they will be restricted from accessing the CENTRIX worksite and will be advised to immediately self-isolate and contact their health care provider or 811 to find out whether or not a COVID-19 test is required. *
Any individual completing this form has an obligation to immediately notify their employer and their CENTRIX contact if their status changes for any of the above questions and to self-isolate when required. *
Full Name *
Company Name *
Form Completed Date *
Which location are you visiting? *
Name of CENTRIX contact you are visiting
A copy of your responses will be emailed to the address you provided.
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