Declaration and Data Privacy Consent Form: By submitting this form, I declare that the information I have given is true, correct, and complete. I understand that failure to answer any question or giving a false answer can be penalized in accordance with the law. I also voluntarily and freely consent to the collection and sharing of the above personal information only with Impact Hub Ottawa Staff and Ottawa Public Health if necessary.
If you answered NO to questions 1-6 , you passed the screening and CAN enter Impact Hub Ottawa.
If you answered YES to any of the first 6 questions , and/or if you did not receive a negative test (RAT, Molecular or other...) test from an authorized health facility as per question 1.a, you did not pass the screening and CANNOT enter Impact Hub Ottawa. Anyone who does not pass screening is advised to not enter the Hub and to self-isolate, ideally at home, and call your health care provider or Telehealth Ontario (1-866-797-0000) to get advice or an assessment, including if you need a COVID-19 test.
If any of your answers to these screening questions change during your visit to Impact Hub Ottawa, you should inform the Hub Team of the change and go home to self-isolate immediately and contact their health care provider or Telehealth Ontario (1-866-797-0000) to get advice or an assessment, including if they need a COVID-19 test.
After your visit to the Hub, if you develop symptoms related to COVID-19 or are exposed to someone who has been diagnosed or is experiencing any of the aforementioned symptoms, please contact email@example.com and relay the following information:
- When you were last at Impact Hub Ottawa - When your symptoms started - if you have been tested.
While respecting your privacy, all those who used the space on the day(s) of your visit will be notified via email.