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COVID Assessment Form

COVID Assessment Form

You are receiving this assessment because you have upcoming business taking place in the offices of Construction Labour Relations Assoc. of BC. You must complete and submit this survey prior to coming to the CLR offices, so please take a moment to complete it now.

"*" indicates required fields

Name
1. Are you experiencing any of the following new or worsening symptoms below? - required*
Fever or chills; Cough; Sore throat; Difficulty breathing; Loss or decrease in sense of taste or smell; Diarrhea; Nausea and/or vomiting; Extreme fatigue; Body aches; Loss of appetite or headache
2. Have you traveled outside of BC or had close contact with anyone who has traveled in the past 14 days? - required*
3. Has there been a known COVID-19 outbreak or exposure in your workplace? If YES, please explain.*
4. Are you currently awaiting results of a COVID 19 test? - required*
5. Have you been told to self-isolate by Public Health? - required*
I certify that i have answered the above questions truly to the best of my knowledge. - required*
I understand that I am required to wear a mask while inside the CLR offices. - required*
This field is for validation purposes and should be left unchanged.

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