COVID-19 Health Declaration
In response to the recent Coronavirus (COVID-19) pandemic, the health and well-being of you, your family and our company is our highest priority.
In order to gain access to our work site please confirm the following:
- I am feeling healthy overall today.
- I do not currently have any symptoms of COVID-19 (fever, chills, cough, sore throat, muscle aches, severe exhaustion/weakness or shortness of breath.).
- I have not had a fever of 38°C / 100.4°F or greater within the past 72 hours.
- I agree to respect physical distancing while on site today.
During the previous 14 days I have not:
- Been advised to self-isolate or quarantine by a doctor or health authority.
- Traveled outside of the country.
- Provided direct care for a COVID-19 case*.
- Lived in the same household as a COVID-19 case.
- Had direct physical contact with a COVID-19 case (e.g. shaking hands) *.
- Had direct contact with infectious secretions of a COVID-19 case (e.g. being coughed on, touching used paper tissues with a bare hand) *.
- Had face-to-face contact with a COVID-19 case within 2 m and > 15 minutes*.
- Been in a closed environment (e.g. classroom, meeting room, hospital waiting room, etc.) with a COVID-19 case for 15 minutes or more, at a distance of less than 2 m*.
- Worked in a laboratory handling specimen from a COVID-19 case.
- Had contact in an aircraft sitting within two seats (in any direction) of a COVID-19 case.
- Had face-to-face contact (within 2 m and > 15 minutes) with any person who was symptom free but developed COVID-19 within 48 hours of our contact.
*Healthcare workers wearing appropriate PPE are exempt.
I cannot think of any reason I should not be allowed access to the work site today.