The questionnaire below is to be completed and submitted by all personnel entering our jobsites.

In line with the recommendations from the Ministry of Health and the Guidelines put in place by the Province of Ontario JP Gravel Construction will require every individual entering our jobsites to fill out the form below.

    1. Have you received all required doses of a World Health Organization or Health Canada approved COVID-19 vaccine (or a combination thereof) and it has been 14 days or more since your final dose? (required)

    2. Are you currently experiencing any of these symptoms? (required)

    • Fever Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or higher or Chills
    • Cough that's new or worsening - Continuous, more than usual, not related to a medical condition you already have (for example, asthma, post-infectious reactive airways, COP Barking cough, making a whistling noise when breathing Croup, not related to a medical condition you already have)
    • Shortness of breath - Out of breath, unable to breathe deeply, not related to a medical condition you already have (for example, asthma)
    • Sore throat - Not related to a medical condition you already have (for example, seasonal allergies, acid reflux)
    • Difficulty swallowing - Painful swallowing, not related to a medical condition you already have
    • Runny nose - Not related to a medical condition you already have (for example, seasonal allergies, being outside in cold weather)
    • Stuffy or congested nose - Not related to a medical condition you already have (for example, seasonal allergies)
    • Decrease or loss of taste or smell - Not related to a medical condition you already have (for example, allergies, neurological disorders)
    • Pink eye - Conjunctivitis, not related to a medical condition you already have (for example, reoccurring styes)
    • Headache that’s unusual or long lasting - Not related to a medical condition you already have (for example, tension-type headaches, chronic migraines)
    • Digestive issues like nausea/vomiting, diarrhea, stomach pain - Not related to a medical condition you already have (for example, irritable bowel syndrome, anxiety in children, menstrual cramps)
    • Muscle aches that are unusual or long lasting - Not related to a medical condition you already have (for example, a sudden injury, fibromyalgia)
    • Extreme tiredness that is unusual. Fatigue, lack of energy, not related to a medical condition you already have (for example, depression, insomnia, thyroid disfunction)
    In the last 5 days have you tested positive for COVID-19? (required)

    Date: