Sign In & Daily COVID Screening Form
To help us reduce the risk of exposure to Covid-19 in our workplace, we ask that you complete the daily screening form below when attending and Country Green Homes location.

In accordance with the Personal Information Protection and Electronic Documents Act, any information you share with us using this form will be kept secure.

If you have answered 'YES' to any of the questions below, you are NOT PERMITTED to attend our worksite. You will be permitted to attend our site once you have been cleared by Public Health.
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Note: You are to use this form for each site you visit. Supervisors will ensure that each person has completed this form for their site.
Name of Company You Work For:  *
Your name, first and last  *
Location(s) you will be working at today (lot # & street name)  *
Time In *
Time
:
Time O
Time
:
Are you well? *
If you have any other reason to believe that you may have Coivd-19 or may have been exposed to Covid-19 you MUST advise the Site Supervisor immediately.
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