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Purpose of the visit:
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.
1. In the past 14 days, have you or any individual living in your household, been in contact with anyone that had a confirmed case of COVID-19?
YesNo
2. In the past 14 days, have you or any individual living in your household, been been under medical investigation, quarantined or tested positive for COVID-19?
3. Have you returned to Canada from an affected region within the last 14 days?
4. Are you or any individual living in your household, currently experiencing any virus/flu-like symptoms that are consistent with those who have diagnosed with COVID-19? Most common symptoms include a cough, fever, difficulty breathing and, and fatigue.
5. If you selected yes to any of the above questions, have you been cleared by Public Health?
YesNoNot Applicable
Upon vising the workplace, you expressly agree to abide by all Health and Safety measures implemented by Akler Browning LLP as outlined below:
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.
Signature: (required). Draw with your mouse or finger (touchscreen only).
