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.

Name*

First Last

Date

Time*

: HH

MM

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. Fever / chills*

2. New Cough or a cough that is getting worse*

3. Difficulty breathing*

4. Shortness of breath (even when sitting or walking regularlry)*

5. Sore throat (not due to allergies)*

6. A runny or congested nose (not due to allergies)*

7. Unusual level of fatigue*

9. Nausea / vomiting, diarrhea, or loss of appetite*

10. Feeling unwell for an unknown reason*

Have you been in close contact with someone who is either sick, sent for testing, or has confirmed COVID-19 in the past 14 days?*

Have you returned from travel outside Canada in the past 14 days?*