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COVID-19 Screening Questionnaire
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* Indicates required question
Full Name
*
Your answer
Company Name
*
Choose
H. Bye Construction Ltd.
Dynamic Millwrights Inc.
M&G Millwrights Ltd.
Ziegler Electric Ltd.
Gas Logics Inc.
Camar Mill Systems Ltd.
Witzel Dyce Engineering Inc.
Horst Systems Ltd.
B.B. Gunn Contracting Ltd.
Bender Construction
Brampton Bolton Crane
Canadian Crane Rental
Cooksville Steel
Doug's Masonry
MWI Silo Systems Inc.
PBW High Voltage
Rawcon Forming
Bailey Miller Painting
Peninsula Overhead Doors
Signature Crane Rentals Inc.
Fraco Products Ltd.
Delta Elevator Co. Ltd.
Kurtis Smith Excavating Inc. (KSE)
Molesworth Farm Supply Ltd.
Spira Fire Protection
Turner Plumbing & Mechanical Ltd.
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
Difficulty breathing or shortness of breath
Cough
Sore throat, trouble swallowing
Runny nose/stuffy nose or nasal congestion
Decrease or loss of smell or taste
Nausea, vomiting, diarrhea, abdominal pain
Not feeling well, extreme tiredness, sore muscles
Yes
No
Fever or chills
Difficulty breathing or shortness of breath
Cough
Sore throat, trouble swallowing
Runny nose/stuffy nose or nasal congestion
Decrease or loss of smell or taste
Nausea, vomiting, diarrhea, abdominal pain
Not feeling well, extreme tiredness, sore muscles
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
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