VISITOR/CONTRACTOR COVID-19 SCREENING TOOL

Complete this form and submit it prior to entering our greenhouse facility for your scheduled appointment . If you answer "Yes" to any of the questions below, DO NOT ENTER OUR FACILITY.

If you have answered "No" to all five questions, then you may enter our facility. You must continue to follow all public health and workplace control measures including masking, physical distancing, and hand hygiene.

Name*

First Last

Date

Time*

:

Who is your scheduled meeting with? (Please Select)*

Company Name*

Phone Number*

Enter your email address if you would like to receive a copy of this screening tool.

1. DO YOU HAVE ONE OR MORE OF THE FOLLOWING COVID-19 SYMPTOMS?*

Yes
No

Only answer "Yes" to this question if it is a NEW or unusual symptom and not related to getting a COVID-19 vaccine in the last 48 hours or a known cause/condition you already have (such as allergies, asthma, COPD etc)

POSSIBLE COVID-19 SYMPTOMS.

Check those that apply.

Fever and / or chills: Temperature of 37.8 degrees Celsius / 100 degrees Fahrenheit or higher.
Cough or barking cough (Croup): Continuous, more than usual, making a whistling noise when breathing.
Shortness of breath: Out of breath, unable to breathe deeply.
Decrease or loss of smell or taste.
Muscle aches / joint pain: Unusual, long-lasting.
Extreme tiredness: Unusual, fatigue, lack of energy.

2. HAS A DOCTOR, HEALTH CARE PROVIDER OR PUBLIC HEALTH UNIT TOLD YOU THAT YOU SHOULD BE CURRENTLY ISOLATING (STAYING AT HOME)?*

Yes
No

(This could be because of an outbreak or contact tracing.)

3. IN THE LAST 14 DAYS, HAVE YOU BEEN IDENTIFIED AS A "CLOSE CONTACT' OF SOMEONE WHO CURRENTLY HAS COVID-19?*

Yes
No

(If you are fully vaccinated and it has been 14 or more days since your final dose of either a two-dose or a one-dose vaccine series and have not been told to self-isolate by public health, select "No".)

4. IN THE LAST 14 DAYS, HAVE YOU TRAVELLED OUTSIDE OF CANADA AND BEEN ADVISED TO QUARANTINE PER THE FEDERAL QUARANTINE REQUIREMENTS?*

Yes
No

(If you are exempt from federal quarantine requirements because you are fully vaccinated and have met the specific conditions, or you are an essential worker who crossed the Canada-US border regularly for work, select "No".)

5. IS ANYONE YOU LIVE WITH CURRENTLY EXPERIENCING ANY NEW COVID-19 SYMPTOMS AND/OR WAITING FOR TEST RESULTS AFTER EXPERIENCING SYMPTOMS?*

Yes
No

(If you are fully vaccinated and it has been 14 days or more since your final dose of either a two-dose or a one-dose vaccine series, select "No". If the person got a COVID-19 vaccine in the last 48 hours and is experiencing a mild headache, fatigue, muscle aches, and/or joint pain that only began after vaccination, select "No".)