This document is to be completed if a member or patron with every contractor/vendor entering the facility. It will be completed by the staff member working with the contractor or the staff member with interacting with the vendor
Fever - Signs of a fever include chills, sweats, muscle aches and lightheadedness YesNo
Coughing YesNo
Sore Throat YesNo
Painful Swallowing YesNo
Runny Nose YesNo
Diarrhea YesNo
Unexplained Loss of Appetite YesNo
Loss of Sense of Smell or Taste YesNo
Small Red or Purple Spots on Hands & Feet YesNo
YesNo
Please note that as you enter the facility, you are still required to abide by physical distancing measures as set out by the government of newfoundland and labrador
Full Name
Date
Signature
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