COVID-19 Screening
Name
*
First Name
Last Name
Email
*
example@example.com
Team Member Home Address
*
Street Address
Street Address Line 2
City
Province
Postal Code
Other Employer #1
Organization Name
Street Address
City
Province
Postal Code
How many hours per week do you work for the above Employer?
Other Employer #2
Organization Name
Street Address
City
Province
Postal Code
How many hours per week do you work for the above Employer?
Other Employer #3
Organization Name
Street Address
City
Province
Postal Code
How many hours per week do you work for the above Employer?
Best Practices
Your safety is our priority! Here are some best practices to keep you and your Members safe.
Wash your hands frequently!
*
I understand
I'd like additional training on this topic
Maintain social distancing
*
I understand
I'd like additional training on this topic
Avoid touching eyes, nose and mouth
*
I understand
I'd like additional training on this topic
Practice respiratory hygiene
*
I understand
I'd like additional training on this topic
Practice respiratory hygiene
*
I understand
I'd like additional training on this topic
If you have fever, cough and difficulty breathing, seek medical care early
*
I understand
I'd like additional training on this topic
Submit
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