COVID-19 Screening Tool

Please complete this form and click “submit”, upon completion it will be forwarded to Sara van der Hoeven, Human Resources Manager. The information recorded in this form is considered private and will be stored securely. When it is no longer necessary to keep the form, it will be destroyed according to privacy requirements. This information will only be used for screening purposes and to support contact tracing efforts.
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    Note: Contact 911 if you are experiencing any symptoms requiring emergency care (e.g., severe difficulty breathing).
    Note: There may be specific quarantine requirements for inter provincial / territorial travel in your province or territory. Refer to the following website for details: Provincial and territorial restrictions
    If the answers to all these questions are “no” then proceed to work. If the answers to any of these questions are “yes” then you should not proceed into the workplace. Immediately discuss with Sara van der Hoeven, Human Resources Manager. You should go home / stay at home and call your health care provider or local public health authority
  • This field is for validation purposes and should be left unchanged.