Client Portal

COVID-19 Form

Akler Browning LLP. Chartered Professional Accountants.

COVID-19 Visitor Screening Form

Please submit this form prior to physically visiting the Akler Browning LLP office.

     

    Akler Browning LLP has implemented a health and safety plan for operation in alignment with local Public Health Guidelines, Health and Safety regulations, and any applicable legislation in Ontario. To ensure the safety of our employees, all individuals visiting our premises at 700-5255 Yonge Street, Toronto must complete the following screening questionnaire. We appreciate your cooperation in sharing this information as strives towards creating a safe environment for all employees and visitors.

     

    Required Screening Questions:

     

    1. Are you currently experiencing one or more of the symptoms below that are new or worsening?

    Symptoms should not be chronic or related to other known causes or conditions. For individuals who are 18 years of age and older.

    YesNo

    Fever and/or chills

    Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or higher

    Cough or barking cough (croup)

    Not related to asthma, post-infectious reactive airways, COPD, or other known causes or conditions you already have

    Shortness of breath

    Not related to asthma or other known causes or conditions you already have

    Sore throat

    Not related to seasonal allergies, acid reflux, or other known causes or conditions you already have

    Difficulty swallowing

    Painful swallowing not related to other known causes or conditions you already have

    Decrease or loss of smell or taste

    Not related to seasonal allergies, neurological disorders, or other known causes or conditions you already have

    Pink eye

    Conjunctivitis (not related to reoccurring styes or other known causes or conditions you already have)

    Runny or stuffy/congested nose

    Not related to seasonal allergies, being outside in cold weather, or other known causes or conditions you already have

    Headache

    Unusual, long-lasting (not related to tension-type headaches, chronic migraines, or other known causes or conditions you already have).
    If you received a COVID-19 vaccination in the last 48 hoursand are experiencing a mild headache that only began after vaccination, select “No.”

    Digestive issues like nausea/vomiting, diarrhea, stomach pain

    Not related to irritable bowel syndrome, menstrual cramps, or other known causes or conditions you already have

    Muscle aches/joint pain

    Unusual, long-lasting (not related to a sudden injury, fibromyalgia, or other known causes or conditions you already have).
    If you received a COVID-19 vaccination in the last 48 hoursand are experiencing mild muscle aches/joint pain that only began after vaccination, select “No.”

    Fatigue

    Unusual tiredness, lack of energy (not related to depression, insomnia, thyroid dysfunction, or other known causes or conditions you already have).
    If you received a COVID-19 vaccination in the last 48 hoursand are experiencing mild fatigue that only began after vaccination, select “No.”

    Falling down often

    For older people

     

    2. Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)?

    This can be because of an outbreak or contact tracing.

    YesNo

    3. In the last 10 days, have you tested positive on a rapid antigen test or a home-based self-testing kit?

    If you have since tested negative on a lab-based PCR test, select “No.”

    YesNo

    4. In the last 14 days, have you been identified as a “close contact” of someone who currently has COVID-19?

    If public health has advised you that you do not need to self-isolate (e.g., you are fully vaccinated* or another reason), select “No.”

    YesNo

    Fully vaccinated is defined as an individual ≥14 days after receiving their second dose of a two-dose COVID-19 vaccine series or their first dose of a one-dose COVID-19 vaccine series.

    5. In the last 14 days, have you received a COVID Alert exposure notification on your cell phone?

    If you are fully vaccinated or have already gone for a test and got a negative result, select “No.”

    YesNo

    6. In the last 14 days, have you travelled outside of Canada AND been advised to quarantine per the federal quarantine requirements?

    YesNo

    7. Is anyone you live with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms?

    If you are fully vaccinated, select “No.”

    YesNo

    If the individual experiencing symptoms received a COVID-19 vaccination in the last 48 hours and is experiencing mild headache, fatigue, muscle aches, and/or joint pain that only began after vaccination, select “No.”

     

    If you answered NO to all questions from 1 through 7 you may enter the workplace.

    If you answered YES to any questions from 1 through 7 you must not enter the workplace, inform your contact at Akler Browning of the result and stay home and contact your healthcare provider or Telehealth Ontario to get advice.

    If you answered YES to question 7 you must stay home, along with the rest of the household, until the sick individual gets a negative COVID-19 test result, is cleared by your local public health unit or is diagnosed with another illness.

    Upon visiting the workplace, you expressly agree to abide by all Health and Safety measures implemented by Akler browning LLP.

    Please submit this form prior to physically vising the Akler Browning LLP by clicking the submit button below.

     

    I attest that the information above is accurate. I agree to abide by the procedures outlined above.