UncategorizedPLEASE FILL OUT THE FORM BELOW SO WE CAN ALL STAY SAFE Date* Date Format: MM slash DD slash YYYY Your Name*Your Email* Phone NumberDo you have any of the following symptoms: Fever/feverish, new or existing cough and difficulty breathing?* Yes No Have you traveled internationally within the last 14 days (outside Canada)?* Yes No Have you had close contact with a confirmed or probably COVID-19 case?* Yes No Have you had close contact with a person with acute respiratory illness who has been outside Canada in the last 14 days?* Yes No Consent* I verify that the information I have provided is correct.If you answer NO to all questions, you are clear to enter the building and report to work. If you answer YES to any of the screening questions you have failed the screening and cannot enter the building. Please contact your local public health unit or Telehealth Ontario for further instructionsPhoneThis field is for validation purposes and should be left unchanged.