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COVID-19
Disclosure Form

    A disclosure of information regarding the possible exposure or contraction of COVID-19 to ensure safety of staff, members and general public entering Alabaster Homes.

    As you are all aware, the virus can be transmitted by asymptomatic people and accordingly the statements made by the signee contained in this document cannot provide certainty that the virus will not be transmitted. Alabaster is taking prudent steps to impose and enforce appropriate protocols to keep members, staff and guests safe, but there can be no assurance that the virus won’t be contracted by members, staff and guests. This is a risk that the signee must assess themselves, and if they choose to come to Alabaster, to take the risk of either contracting the virus or transmitting it to others.

    In the past 14 days, have you or anyone in your household had:*

    Sudden onset of respiratory illness (congestion, nasal drainage, difficulty breathing)?

    Fever (temperature greater than 38°C)?

    Cough and/or sore throat?

    Have you or anyone in your household travelled outside of Canada in the past 14 calendar days? *

    Please confirm below*

    I confirm that the above information given is correct.

    I understand that if the answer is “Yes” to any of the questions above, additional information may be required before I can access the office or enter a job site.

    I also understand that if I am a repeat visitor to the office, I must report any change to my answers above to the Operations Manager before arrival. (jc@pavilioncowork.com)

    Information:*

    By completing this form, you are consenting to the collection of personal information provided by you to Alabaster Homes. This information is being collected to ensure the health and safety of our employees and members in compliance with the recommendations of the Provincial Health Officer to protect against the spread of COVID-19.