Covid-19 Questionnaire for SMP Members

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To prevent the spread of COVID-19 and reduce the potential risk of exposure to our members and
visitors, we are conducting a simple screening questionnaire. Your participation is important to help us take precautionary measures to protect you and everyone in the Printshop. Thank you for your time.

Please indicate your response to the following. Admittance will not be granted without completion.

Email *

Have you travelled outside of Newfoundland and Labrador (excluding Nova Scotia, New Brunswick and Prince Edward Island), or Canada within the last 14 days? *

Yes

Have you provided care or had close contact with a person with COVID‐19(probable or confirmed) within the past 14 days? (If you have been cleared by public health to return to work, answer No) *

Yes

Do you have any of the following symptoms (new or worsening)? *

Fever (or signs of fever such as chills, sweats, muscle aches and lightheadedness

Cough

Loss of sense of smell or taste

Headache

Small red or purples spots on your hands and/or feet

Sore throat

Painful swallowing

Runny nose

Diarrhea

Unexplained loss of appetite

Yes (check which ones)

Required

If you responded NO to all questions, you may book a time and press and work in SMP

If you have answered “YES” to any of the questions numbered 1-6 or if your temperature reading is greater than 100.4 degrees Fahrenheit / 38 degrees Celsius, access to the Printshop will not be permitted and it is recommended that you contact 811. ***If you have been in the Printshop and start to have symptoms or test positive for Covid-19 you must notify SMP immediately at stmichaelsprintshop@gmail.com

I agree that: I have read the COVID-19 Terms of Use Policy and will conduct myself in accordingly; -- I have completed the above questionnaire to the best of my knowledge, information and belief -- I will advise St. Michaels’ Printshop if I test positive for COVID-19 within 14 days from the date hereof -- I acknowledge that my studio privileges may be suspended or revoked at any time if my conduct is contrary to the above or to the COVID-19 Terms of Use Policy. *

I agree

Name *

Date *

YYYY

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