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Covid Questionnaire
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Covid-19 Health Declaration
How are you feeling today?
First Name
Last Name
Phone
I am not sick with a cold/flu and am not displaying any signs of Covid-19 and/or flu-like symptoms
I have not returned from outside the country (including Canada/ USA) in the past 14 days
In the past 14 days, at work or elsewhere, I have not been in close contact with someone who has a probable or confirmed case of COVID-19
Approximate Time
Date
I declare that the info I’ve provided is accurate & complete
Submit
Thanks for submitting!
