Colib

Phone number *

Resident and employee health and safety is taken very seriously at PARC Retirement Living.

Please complete the following screening questions not more than 24 hours prior to your visit.

Reason for Visit

Reason for Visit *

What is the name of the Resident you are visiting? *

What is the name of your organization/company? *

What is the NAME and SUITE NUMBER of the Resident you are visiting?

Please provide detail *

Vaccination Status

Have you received two or more COVID-19 vaccinations? *

NoYesNo

Has it been more than 14 days since you received the second dose? *

NoYesNo

Have you provided proof of your vaccination status to Reception on a prior visit? *

NoYesNo

Travel Disclosure

If you have been outside of BC and returned in the past 14 days, you will be required to have a COVID rapid test performed upon entry to the PARC community, or provide proof of a negative test 5 days after entry to BC.

Have you traveled outside of BC in the past 14 days? *

NoYesNo

What date did you return to BC? *

If you answer 'YES' to the following question, please provide your ArriveCAN documentation to the Receptionist.

If you have returned from international travel, have you satisfied your ArriveCAN requirements? *

NoYesNo

COVID-19 Symptom Check

To keep our residents and staff safe, please carefully assess for symptoms daily.

Fever (over 37° Celsius or 100.4° Fahrenheit)? *

NoYesNo

Difficulty Breathing or Shortness of Breath *

NoYesNo

Loss of sense of smell or taste *

NoYesNo

Worsening cough of sore throat *

NoYesNo

Nasal Congestion *

NoYesNo

Nausea / Vomiting or Diarrhea *

NoYesNo

Headache *

NoYesNo

Increased or unusual fatigue *

NoYesNo

Have you been tested for COVID-19 in the last 14 days? *

NoYesNo

If you have not been tested and have any of the above symptoms, you are not permitted entry.

If you received a POSITIVE test result in the past 14 days or are awaiting results, you are not permitted entry.

Was the result POSITIVE? *

NoYesNo

General Disclosure Form

Thanks for completing the form.

The information has been received.

Click the link below to learn how Colib can help you and your company with digital forms.

Thanks for completing the form.

The information has been received.

Click the link below to learn how Colib can help you and your company with digital forms.

Reason for Visit

Vaccination Status

Travel Disclosure

COVID-19 Symptom Check

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