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. IN THE LAST 5 DAYS ( 10 DAYS if you are not fully vaccinated or you are immunocompromised) HAVE YOU EXPERIENCED ANY OF THE COVID-19 SYMPTOMS BELOW?*

Yes
No

Choose "YES" if any are new, worsening, and not related to other known causes including getting a COVID vaccine in the last 48 hours or conditions you already have such as allergies, etc. Select "NO" if you have already completed your isolation period of 5 days, and you don't have a fever, and your symptoms have been improving for over 24 hours (48 hours if you have nausea, vomiting, and/or diarrhea).

POSSIBLE COVID-19 SYMPTOMS.

Check those that apply.

2. IN THE LAST 14 DAYS, HAVE YOU TRAVELLED OUTSIDE OF CANADA AND BEEN TOLD TO QUARANTINE (per the federal requirements)?*

Yes
No

3. HAS A DOCTOR, HEALTH CARE PROVIDER, OR PUBLIC HEALTH UNIT TOLD YOU THAT YOU SHOULD CURRENTLY BE ISOLATING (staying at home)?*

Yes
No

4. IN THE LAST 5 DAYS ( 10 DAYS if you are not fully vaccinated or you are immunocompromised), HAVE YOU TESTED POSITIVE FOR COVID-19?*

Yes
No

This includes a positive COVID-19 test result on a lab-based PCR test, rapid molecular test, rapid antigen test, or home-based self-testing kit.

5. DO YOU LIVE WITH SOMEONE WHO IS CURRENTLY ISOLATING BECAUSE OF COVID-19 SYMPTOMS, A POSITIVE COVID-19 TEST RESULT OR WAITING FOR A COVID-19 TEST RESULT?*

Yes
No

Select "No" if : * You are 18 or older and have received your booster, and/or * You are 17 or younger and are fully vaccinated, and/or * You completed your isolation after testing positive in the last 90 days (using a rapid antigen, rapid molecular, or PCR test) and/or * Your household member is isolating because of COVID-19 symptoms but has already tested negative on one PCR or rapid molecular test, or two rapid antigen tests