Form Builder

COVID-19 Contractor or Visitor Screening Questionnaire

July 21, 2021

Please complete this questionnaire to request an appointment  or before entering any Town Site.  Contractors this is required daily.

To answer question number 5 review if exempt from Federal quarantine requirements.

For Visitors Only 

If you answered YES to any of these questions, do not enter the Town site.  Please contact the Town immediately. 

Completion of this declaration is mandatory.  Failure to provide information will prevent you from entering or visiting a Town facility.  Please complete your details to confirm you have read and understand this declaration.

Declaration

  1. I acknowledge COVID-19 has a long incubation period during which carriers of the virus may not show symptoms and still be contagious and that I have an elevated risk of contracting COVID-19 by being around other people in a public setting, and I hereby assume the risks with respect to acquiring COVID-19 inherent in participating in work, or participating in activities and programs at a Town of Gravenhurst site(s), including the associated risk of death or severe bodily injury that may accompany COVID-19.
  2.  I hereby release and save harmless The Corporation of the Town of Gravenhurst and its employees and representatives from any and all claims and demands associated with my acquiring COVID-19, from working at or visiting a Town of Gravenhurst site, due to any cause whatsoever, including negligence, breach of contract, mistakes or errors in judgment. This Release of Liability shall be binding upon my heirs, next of kin, executors, administrators, assigns and representatives.
Clear

When you arrive at the facility:

You will be required to wear a face mask or face covering and sanitize your hands when you enter.  Please note that public washroom facilities are currently closed at our facilities.



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