Ontario Mandatory Screening Questions
Daily Employee, Visitor & Contractor Check-In for Forterra Facilities
Your name
*
First Name
Last Name
Date of visit to facility
*
-
Day
-
Month
Year
Facility/Office being visited
*
Please Select
Cambridge
Cambridge - Plant 1
Cambridge - Plant 2
Cambridge - Plant 3
Cambridge - Shipping Office
Cambridge - Main Office
Ottawa
Ottawa - Shipping
Whitby
Uxbridge
Stouffville
Your email address OR
You will be emailed a copy of this form
Your Phone Number
Your number will only be used for contact tracing
Do you have any of the following (either new or worsening) symptoms or signs?
Symptoms should not be chronic or related to other known causes or conditions.
Fever or Chills? Difficulty breathing, shortness of breath or coughing? Sore throat, trouble swallowing? Runny nose, decrease or loss of smell and taste? Nausea, vomiting, extreme tiredness or just not feeling well?
*
Yes
No
Have you been told to isolate or quarantine by Health Canada, Public Health, or by Immigration Canada in the last 14 days?
*
Yes
No
Have you had close contact with a confirmed or probable case of COVID-19?
*
Yes
No
Submit
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