COVID Access Screening Questionnaire

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COVID-19 ACCESS SCREENING QUESTIONNAIRE

FILL OUT THIS MANDATORY QUESTIONNAIRE TO DETERMINE IF YOU SHOULD BE ENTERING OUR FIRM TODAY

* Full Name

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* Contact Email and/or Phone Number

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* Meeting with Lawyer

Patricia Daunais

Heather McKay

Diane Harms

Patricia Sealy

Michael Ghert

Bradley Collin Smith

Lainie Chan

Jonathan Griffith

Imogen Jenkins

Emily Koch

Timothy S. Chan Student-at-Law

Do you have any of the following symptoms:

Fever (greater than 38 degrees)

Cough

Shortness of breath/breathing difficulties

Other symptoms such as muscle aches, fatigue, headache, sore throat, runny nose, diarrhea.

*Note symptoms in young children may be non-specific: e.g. lethargy, poor feeding

* Have you travelled outside of Canada in the last 14 days?

Yes

* Have you had close contact (face-to-face contact within 2 meters/6 feet) with someone who is ill with cough and/or fever?

Yes

* Have you been in contact in the last 14 days with someone that is being investigated or confirmed to be a case of COVID-19?

Yes

* Have you had laboratory exposure while working with specimens known to contain COVID-19?

Yes

If you are an essential worker with PPE Please note your occupation below:

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IF YOU HAVE ANSWERED “YES” TO ANY OF THE ABOVE QUESTIONS OR BULLETS, PLEASE DO NOT ENTER OUR FIRM AT THIS TIME.

If you have answered “No” to all the able questions and bullets, or are an essential worker with PPE, please select Submit Survey at the bottom of the page.

If you are permitted to enter our firm premises, please make sure you check in and out and practice hand hygiene (i.e. wash your hands for 30 seconds and/or use hand sanitizer) before and after your meeting.

Our goal is to minimize the risk of infection to yourself, our firm and others who attend at our office, and we thank you for your understanding, support and cooperation.

Submit Survey