Visitor/Vendor COVID-19 Screening Questionnaire

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The safety of our employees, customers, families and visitors remains DECAST's top priority. As the COVID-19 outbreak continues to evolve and spreads globally, DECAST is monitoring the situation closely and will periodically update our protocols based on the current recommendations from health authorities.

To prevent the spread of COVID-19 and reduce the potential risk of exposure to our employees and visitors, we are conducting a simple screening questionnaire. Your participation is important to help us take precautionary measures to protect you and our workplace.

Name *

Company *

Phone Number *

Name of DECAST Host *

Have you returned from travel outside of Canada within the last 14 days? *

Yes

Option 1

Clear selection

If you indicated YES, which country did you travel to?

Have you had close contact with or cared for someone diagnosed with COVID-19 within the last 14 days? *

Yes

Have you been in close contact with anyone who has traveled outside of Canada within the last 14 days? *

Yes

If you indicated YES, which country did they travel to?

Have you experienced any cold or flu-like symptoms in the last 14 days (to include fever, cough, sore throat, respiratory illness, difficulty breathing)? *

Yes

Your submission will be stored at DECAST's gatehouse.

Note: If you plan to be onsite for consecutive days, please immediately advise your host if any of your responses change. The information collected on this form will be used to determine your access to DECAST facilities.

For more information, contact Marlo Harley, Manager Health, Safety & Training mharley@decastltd.com

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