COVID-19 SCREENING FOR CONSTRUCTION SITE

If you are attending one of our construction sites, please fill this form out prior to coming to the site.

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.

Do not enter if any of the following apply:

*Company Name

*Employee Name

*Job Site Name

*Job Site Address

*Number of Employees

*SymptomsFever or ChillsDifficulty breathing or shortness of breathCough or barking cough (croup)Decrease or loss of smell or tasteNausea, vomiting, diarrhea, abdominal painNot feeling well, extreme tiredness, sore musclesNone of the Above

*Have you travelled outside of Canada in the past 14 days?YesNo

*Have you had close contact with a confirmed or probable case of Covid-19?YesNo

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If you answered no to all questions 1 – 3, you have passed and can enter the workplace.

If you answered Yes to any questions 1 – 3 you have not passed and should not enter the workplace (including any outdoor, or partially outdoor workplaces). You should go home to self-isolate immediately and contact your healthcare provider or your local Public Health unit to find out if you need a Covid-19 test.