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COVID-19 Screening Forms

Name: Cunningham Sheet Metal (Windsor) Ltd.
Address: 2060 Blackacre Dr., Oldcastle, ON, N0R 1L0, Canada
Telephone: 519-737-1908

We are always excited to welcome you to our plant. However, considering the current COVID-19 situation, it is important for us to ensure the safety of every visitor. That’s why we request you to fill out the below-given eform depending on the nature of your visit. Please note that filling the eform is mandatory for anyone visiting our plant. We thank you for your consideration and support.

For The Visitors

For The Staff

For the Visitors

Name:*

Date:*

Company Name:*

Do you agree to wear a mask for the entire visit? *

Yes

Must Be Completed Before Each Shift

Required Screening Questions

1. Do You Have Any of the Following Symptoms or Signs? Symptoms Should Not Be Chronic or Related to Other Known Causes or Conditions Such As Seasonal Allergies or Common Cold.

Fever or chills

Yes

Difficulty breathing or shortness of breath

Yes

New or worsening cough

Yes

Sore throat, trouble swallowing

Yes

Runny nose/stuffy nose or nasal congestion not related to seasonal allergies or cold

Yes

Decrease or loss of smell or taste

Yes

Nausea, vomiting, diarrhea, abdominal pain

Yes

Not feeling well, extreme tiredness, sore muscles

Yes

2. Have you travelled outside of Canada in the past 14 days?

Yes

3. Have you had close contact with a confirmed or probable case of COVID-19?

Yes

Results of Screening Questions:

If the Individual Answers No to All the Questions From 1 Through 3, They Have Passed and Can Enter the Workplace.

If the Individual Answers Yes to Any Questions From 1 Through 3, They Have Not Passed and Should Be Advised That They Should Not Enter the Workplace (Including Any Outdoor, or Partially Outdoor, Workplaces). They Should Go Home to Self-Isolate Immediately and Contact Their Health Care Provider or Telehealth Ontario (1 866-797-0000) to Find Out if They Need a COVID-19 Test.

For the Staff

Name:*

Date:*

Must Be Completed Before Each Shift

Required Screening Questions

1. Do You Have Any of the Following Symptoms or Signs? Symptoms Should Not Be Chronic or Related to Other Known Causes or Conditions Such As Seasonal Allergies or Common Cold.

Fever or chills

Yes

Difficulty breathing or shortness of breath

Yes

New or worsening cough

Yes

Sore throat, trouble swallowing

Yes

Runny nose/stuffy nose or nasal congestion not related to seasonal allergies or cold

Yes

Decrease or loss of smell or taste

Yes

Nausea, vomiting, diarrhea, abdominal pain

Yes

Not feeling well, extreme tiredness, sore muscles

Yes

2. Have you travelled outside of Canada in the past 14 days?

Yes

3. Have you had close contact with a confirmed or probable case of COVID-19?

Yes

Results of Screening Questions:

If the Individual Answers No to All the Questions From 1 Through 3, They Have Passed and Can Enter the Workplace.

Check out some of our specialty metal work:

Company

Cunningham Sheet Metal (Windsor) Ltd.

2060 Blackacre Dr.
Oldcastle, ON N0R 1L0

CONTACT INFO

Phone: 519-737-1908

Fax: 519-737-1679

Email:
info@cunninghamsheetmetal.com

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