Covid-19 Health Screening Tool- AB Construction Site

COVID-19 HEALTH SCREENING TOOL – AB CONSTRUCTION SITE

*Require Fields

Company Name*
Number of workers on site*
Screening completed by*
Phone*
Date*
Date Format: MM slash DD slash YYYY
Please confirm the following three questions with each member of your team daily prior to shift starts and submit to Vesta Properties Ltd.
1.Are you or any members of your team experiencing, or have experienced any of these symptoms in the past 10 days?*
- Yes
- No
- - Fever (38°C or 100.4°F)
- - New onset or worsening of existing cough
- - New onset or worsening of sneezing/running nose
- - Sore throat or painful swallowing
- - Shortness of breath or difficulty breathing
- - Severe fatigue
- - Loss of sense of smell
- - New onset or worsening headache
- - New or worsening muscle ache
- - Loss of appetite
2. Have you or any members of your team travelled to any countries outside Canada (including the United States) within the past 14 days?*
- Yes
- No
3. Have you or any members of your team been directed by public health to self-isolate?*
- Yes
- No
Comments
Consent*
I hereby confirm that none of my team members have answered yes to any of the above noted questions.
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Comments
This field is for validation purposes and should be left unchanged.