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Atlantic Region Committee Meetings
Mandatory COVID-19 Self-Assessment (for EFC in-person Meetings)
Provincial regulations require organizers to provide screening methods to participants in advance of each event/meeting. Please take this brief self-assessment and submit this form before the scheduled event/meeting. You are reminded to please bring a face mask and maintain a 2-metre distance at all times during this meeting/event.
Which Province or Territory are you currently located in?
*
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Ontario
Prince Edward Island
Quebec
Saskatchewan
Northwest Territories
Nunavut
Yukon
Have you travelled outside of Canada in the last 14 days?
*
No
Yes
Have you been, or will you be, outside of the Atlantic bubble prior to the event date of December 1st, 2020?
*
If you respond yes, you will not be permitted to attend this event due to the 14 day self-isolation restrictions.
No
Yes
In the last 14 days, have you been in contact with someone who has COVID-19?
*
This includes getting a COVID Alert exposure notification.
No
Yes
Are you currently experiencing any of these symptoms? (select all that apply)
Please note: Should you experience, any of these symptoms on December 1st, 2020, please do not attend.
Cough
Fever
Difficulty breathing
Symptoms associated with the flu or cold (fatigue, chills, runny nose, congestion, sore throat, muscle soreness or muscle ache)
Decrease or loss of taste or smell
Extreme fatigue
Today's Date
*
Full Name
*
Email Address
*
Company Name
Phone Number
*
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