Copy of COVID Declaration | Men with Knives

MWK Staff Covid-19 Health Declaration

How are you feeling today?

Please complete prior to arriving at Alpine Ski Club for your shift.

Do not forget your mask!

First Name

Last Name

Phone Number

Contact Name (if under 18):

My body temperature is lower than 98.6°F/ 37.5°C

I am not experiencing new or worsening symptions: fever, chills, cough, shortness of breath, difficulty breathing, fatigue, muscle or body aches, loss of taste or smell, feeling unwell

I have not been in close physical contact with a known positive case or suspected case of COVID 19 in the past 14 days

I am not under direction to isolate or quarantine

I have not travelled outside of Canada in the past 14 days.

I have not been in close contact with anyone with COVID 19 symptoms or has returned from outside of Canada in the past 14 days.

Initials

Date

I declare that the info I’ve provided is accurate & complete

Signature (or Parent/Guardian if individual is a minor):

Stay Safe! If you are experiencing any symptoms or have any concerns regarding

work please contact your supervisor.

Men with Knives Catering

17-242 Arrowhead Road

Collingwood, ON L9Y 0S1

705 888 8233 / info@menwithknives.ca