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Covid-19 Screening - Family Chiropractic Centre

Do you have any of the following new or worsening symptoms or signs? Symptoms should not be chronic or related to other known causes or conditions

Travel & Exposure risk

If you answered NO to all questions, you are cleared to enter the workplace. If you answered YES to any of the questions, you are not granted permission to enter the workplace.  You should immediately go home to self-isolate, and contact your local health care provider or Telehealth Ontario (1-866-797-0000) to find out if you need a Covid-19 test. 

I certify the information above is complete and accurate. I acknowledge that the information on this form will be kept securely stored and encrypted on Colib website, viewable by the organization I plan to visit.

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