COVID-19 PRE-SCREENING QUESTIONNAIRE
With the number of Coronavirus (COVID-19) cases rising daily and concerns of whether an outbreak could overwhelm our healthcare systems, we feel it is of paramount importance to be proactive in the way our clients and trades with whom we work alongside of are screened, in the event they are exposed to or are at risk of exposure to COVID-19. In order to ensure the best interests of our staff when working with you and other trades in-person on job sites, we respectfully require everyoneโ€™s co-operation to assist us in determining whether or not we are able to provide in-person services on your job site(s).

These questions apply to all people who will be on your job site(s) during the course of in-person services by our staff. The person completing this questionnaire is required to answer on behalf of everyone in their party. ๐—ช๐—ฒ ๐—ฎ๐˜€๐—ธ ๐˜๐—ต๐—ฎ๐˜ ๐—ฐ๐˜‚๐˜€๐˜๐—ผ๐—บ๐—ฒ๐—ฟ๐˜€ ๐—น๐—ถ๐—บ๐—ถ๐˜ ๐˜๐—ต๐—ฒ๐—ถ๐—ฟ ๐—ฝ๐—ฎ๐—ฟ๐˜๐˜† ๐˜๐—ผ ๐—ฎ ๐—บ๐—ฎ๐˜…๐—ถ๐—บ๐˜‚๐—บ ๐—ผ๐—ณ ๐Ÿฏ ๐—ฝ๐—ฒ๐—ผ๐—ฝ๐—น๐—ฒ ๐˜„๐—ต๐—ฒ๐—ป ๐˜ƒ๐—ถ๐˜€๐—ถ๐˜๐—ถ๐—ป๐—ด ๐—ผ๐˜‚๐—ฟ ๐˜€๐—ต๐—ผ๐˜„๐—ฟ๐—ผ๐—ผ๐—บ.

Please answer the following questions honestly and as accurately as possible:
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Name of Company Screened *
Have you enforced that if any of the trades entering your job site have traveled outside of Canada within the last 14 days they are required to self-isolate for a minimum of 14 days? *
Have you enforced that if any of the trades entering your job site have been in contact with someone who has traveled outside of Canada within the last 14 days they are required to self-isolate for a minimum of 14 days? *
Have you enforced that if any of the trades entering your job site have come into close contact (within 6 feet) with someone who has a confirmed COVID-19 diagnosis within the last 14 days they are required to self-isolate for a minimum of 14 days? *
Have you enforced that if any of your trades entering your job site who have a new onset of any of the following symptoms: Fever/Chills, Runny nose/Sneezing, Sore throat/hoarse voice, Headache, Vomiting or diarrhea for more than 24 hours, Cough, Shortness of breath, Fatigue, Muscle aches are required to quarantine for a minimum of 14 days or until symptoms are cleared?โ€ *
Have you advised the trades entering your job sites of social distancing requirements to maintain a minimum of 6 feet distance from others? *
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