Visitor and Employee Self Declaration Form

    The safety of our employees, customers, families and visitors remains our overriding priority at Electric Motor Service Limited. As the coronavirus disease 2019 (COVID-19) outbreak continues to evolve and spread globally, we are monitoring the situation closely and will periodically update company guidance based on current recommendations from Heath Canada, the Center for Disease Control and the World Health Organization.

    To prevent the spread of COVID-19 and reduce the potential risk of exposure to our employees and visitors, we are conducting a simple screening questionnaire. Your participation is important to help us take precautionary measures to protect you and everyone in this building. Thank you for your time

    Self-Declaration by Employee/Visitor

    *Close contact is defined as: a) being within approximately 6 feet (2 meters) of a COVID-19 case for a prolonged period of time; close contact can occur while caring for, living with, visiting or sharing a healthcare waiting area or room with a COVID-19 case – or – b) having direct contact with infectious secretions of a COVID-19 case (e.g., being coughed on)

    *If it is deemed by a supervisor or manager that you may have a fever you must self-assess before starting work or being admitted to the site.