Rosedale COVID-19 Self Screening Questionnaire

You must answer “NO” to all the questions in this questionnaire in order to enter our physical location. If you answer “YES” to any of the questions, please DO NOT enter the company’s buildings.

If you experience any symptoms or answer “YES” to any of these questions, you must immediately contact your health care professional for recommended next steps AND notify your manager and HR.

Cross Border Highway Drivers and Owner Operators:

We are an essential service and you do not have to answer “yes” to question 1 or 3 if you have travelled outside of Canada for Rosedale business or have been in contact with another Cross Border Driver or Owner Operator who has also been outside of Canada on Rosedale business.

Answer the following four questions: *

Yes

No

Have you returned from any countries outside Canada?

Have you had close contact with or cared for someone diagnosed with COVID-19 or who has experienced any cold or flu-like symptoms in the last 14 days?

Have you been in close contact with anyone who has travelled within the last 14 days outside of Canada?

Have you experienced any cold or flu-like symptoms in the last 14 days (to include fever, cough,
sore throat, respiratory illness, difficulty breathing, headache)?

Rosedale Transport’s Visitor Protocol

When in a Rosedale Transport facility you will be required to:

Sanitize your hands upon arrival. (rub in for 15 seconds for effectiveness)
Complete visitor questionnaire to determine access to facility
Refrain from handshakes and physical contact
keep physical distance of 6 feet (2 meters) from others
Wear a mask during your visit at all times

In the event you do not adhere to our protocol you may be requested to vacate the premises as we have these in place for everyone’s safety.

To prevent the spread of COVID-19 and reduce the potential risk of exposure to our workforce and visitors, we are conducting a simple screening questionnaire. Your participation is important to help us take precautionary measure to protect you and everyone in this building. Thank you for your time.

I certify to the best of my knowledge; this information is accurate:

Signature *

Clear

Name *

First Name Last Name

Date *

Date

Terminal you are reporting to / visiting: *

Associate / Visitor COVID-19 Self Screening Questionnaire