COVID | tatconstruction

COVID 19 - SELF ASSESSMENT

Project Location

First Name

Last Name

Phone

In the past 14 days, have you returned from travel to any other locations outside of Canada?

YES

Do you have any of the following unexplained minor symptoms: Fever, chills, cough that is new or worsening, barking cough (making a whistling noise when breathing), shortness of breath, difficulty swallowing, stuffy or congested nose, pink eye, runny nose, sore throat, headache, muscle ache, nausea, anosmia (loss of smell), extreme tiredness that is unusual, falling down often, diarrhea or difficulty breathing?

YES

Has someone in your household, whom you have had close contact with and not worn PPE, tested positive for COVID-19?

YES

In the last 14 days, have you been in close physical contact with someone who has tested positive for COVID-19? Close physical contact means: being less than 2 metres away in the same room, workspace or area or living in the same home.

YES

Thanks for submitting!