290 Lake Road - Lakeside Self Storage COVID-19 Screening Tool

This information is collected to ensure the safety of all visitors on Graycraft Homes projects including employees, contractors and workers during a pandemic, none of the information is to be used in the future. This information will be kept confidential and properly discarded at the end of the pandemic. This checklist is to be completed weekly prior to job site entry during a pandemic weekly.

Do You understand the purpose of this document?

In effort to keep everyone safe during the COVID-19 Coronavirus Pandemic Graycraft Homes is taking precautionary steps to ensure the safety of all staff and visitors on our sites. Please fill in the following information and answer all questions.


1. Have you been advised to self-isolate by a doctor/Heath Canada in the last 14 Days?
2. Do you reside with someone who has been in self-isolation in the last 14 days?
3. Do You have a Fever?
4. Do You have a Cough?
5. Do You have Shortness of Breath?
6. Have you been in contact with someone diagnosed with COVID-19 in the last 14 days?
7. Do you agree to social distance yourself from others and maintain a distance of at least 2 meters from anyone on site?
8. Do you have the proper Personal Protective Equipment to do your job safely?
9. After signing this document it is your responsibility to inform us if you come in contact with anyone that has COVID-19 or to inform us if you begin to show any symptoms of COVID-19. If you do come in contact or begin to show symptoms, you are required to stay home and quarantine for a minimum of 14 days. Do you understand?


In effort to keep everyone safe during the COVID-19 Coronavirus Pandemic Graycraft Homes is taking precautionary steps to ensure the safety of all staff and visitors on our sites. This form is designed to confirm that you do not have any symptoms of COVID-19 or have not been in contact with anyone who has COVID-19. If you understand this check the box yes and fill in the form.





SORRY YOU WILL NOT BE GRANTED ACCESS TO OUR JOB SITE. PLEASE COME BACK WHEN YOU ARE FEELING BETTER

Prior to entering the Property consider the health and safety of others. Please note that no access will be granted to anyone who has not completed this form and received a clearance email. Thank You for your co-operation

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