Employee COVID Self Assessment
Please fill this form out daily. If you indicate you are experiencing symptoms or answer yes to any questions below, you will not be permitted to enter the premises.
In this case please contact your supervisor to discuss next steps.
Please note, only check off symptoms if they are not chronic or related to a known cause or issue that is not COVID related.
Do you have any of the folloing new or worsening symptoms or signs?
Have you travelled outside of Canada in the past 14 days?
Have you had close contact with a confirmed or probable case of COVID-19?
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1184 Plains Rd E, Burlington, ON    1-800-883-0761  F.905-637-2009

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