Questionnaire to be completed by all personnel entering the site

OakWood wishes to take preventative measures to ensure the health and safety of all its employees, visitors and those around them, as well as its working environment. Please complete this short questionnaire to ensure your presence does not pose a risk to the project and to return the completed form to the Site Superintendent, Project Manager or OakWood office. All employees assigned to this site must complete this form and submit to info@www.oakwood.ca prior to entering the site.

Name*
First Last
Cell Phone*
Employer*
1. Have you travelled outside of Canada in the last 14 days?*
- Yes
- No
If Yes - Date of Return? (must be 14 days min to stay on site)
2. Do you currently have the following symptoms: fever, coughing and difficulty breathing?*
- Yes
- No
3. Have you been exposed to a person who has a confirmed or probable case of the COVID-19 infection?*
- Yes
- No
4. Is anyone you live with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms?*
- Yes
- No
Declaration:*
I hereby confirm that the information provided herein is accurate, correct and complete and that the responses submitted within this form are genuine. I undertake to inform OakWood in writing of any changes to the information already provided and to update the information on this form whenever requested to do so by.
Date*
MM slash DD slash YYYY

To download form for print click here