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

In response to COVID-19, effective March 20, 2020, all visitors must complete this Self-Declaration Form on the same day of your scheduled visit and prior to entering any ICONIX facility.

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

Learn more:
Email *
Have you, or anyone you have been in close contact with, travelled outside of Canada within the past 14 days? *
Are you, or anyone that you have been in close contact with, experiencing flu-like symptoms (i.e. cough, sore throat, fever, difficulty breathing, etc.)? *
Have you been in close contact with anyone who has tested positive OR is presumed positive for COVID-19 within the past 14 days? *
Have you been advised to self-isolate by the local health authority? *
Applicable visitors must ensure that this form is completed in full and submitted to the ICONIX contact person prior to entrance at any ICONIX location. If a visitor fails to comply with these requirements or answers "YES" to any of the questions above, they will not be permitted on our site. *
Any individual completing this form has an obligation to immediately notify their employer and their ICONIX 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 ICONIX contact you are visiting
A copy of your responses will be emailed to the address you provided.
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