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Hardwood Flooring
Carpet Tiles
Gallery
About
Blog
Careers
Contact
Get a quote
Screening Form
Screening Form
Screening
Daily screening
Name
*
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.
Fever or chills
*
Yes
No
Difficulty breathing or shortness of breath
*
Yes
No
Cough
*
Yes
No
Sore throat, trouble swallowing
*
Yes
No
Runny nose/stuffy nose or nasal congestion
*
Yes
No
Decrease or loss of smell or taste
*
Yes
No
Nausea, vomiting, diarrhea, abdominal pain
*
Yes
No
Not feeling well, extreme tiredness, sore muscles
*
Yes
No
Have you travelled outside of Canada in the past 14 days?
*
Yes
No
Have you had close contact with a confirmed or probable case of COVID-19?
*
Yes
No
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