1 877.401.3423
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COVID-19 Employee Required Screening Questions
First Name
*
Last Name
*
Email Address
*
Location
401 Auto RV Canada Inc has been deemed an essential business as per Ontario Regulation 82/20 (O.Reg. 82/20) Auto Dealerships are considered an essential service
The employee listed above is an essential worker and is granted the ability to travel from their home to their location for their respective shifts and or between our facilities in order to execute the operational requirements of their essential position.
Any questions can be directed to Stephanie Reece at (226) 779-5829 or stephanie.reece@401auto.ca
Do you have any of the following NEW or WORSENING symptoms or signs?
Symptoms should not be chronic or related to other known causes or conditions.
Fever or Chills
*
Yes
No
Difficulty Breathing or Shortness of Breath
*
Yes
No
Cough
*
Yes
No
Sore Throat, Trouble Swallowing
*
Yes
No
Runny Nose/Stuff Nose or Nasal Congestion
*
Yes
No
Decrease or Loss of Smell or Taste
*
Yes
No
Nausea, Vomiting, Diarrhea, Abdominal Pain
*
Yes
No
Not Feeling Well, Extreme Tiredness, Sore Muscles
*
Yes
No
Have you Travelled outside of Canada in the past 14 days?
*
Yes
No
Have you had close contact with a confirmed or probable case of COVID-19?
*
Yes
No
Date
*
Date Format: MM slash DD slash YYYY
