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  • Name

  • The safety of our employees, supplier partners, customers, families, and visitors remains Kananaskis Nordic Spa's overriding priority. As the coronavirus disease 2019 (COVID-19) outbreak continues to evolve and spreads globally, Kananaskis Nordic Spa is monitoring the situation closely and will periodically update company guidance based on current recommendations from Pomeroy Lodging, Alberta Health Services and the Public Health Agency of Canada. Only business-critical visitors are permitted at Kananaskis Nordic Spa at this time. To prevent the spread of COVID-19 and reduce the potential risk of exposure to our workforce and visitors, we are conducting a simple screening questionnaire. Your participation is important to help us take precautionary measures to protect you and everyone on our property and the community. Thank you for your time.

  • Employee category

  • Department

  • Employee ID Number

  • Name of Contractor

  • Company or Organization Name

  • Contact number (Mobile/Home)

  • Work Area

  • Name

  • Department

  • Employee ID Number

Self-Declaration by Employee/Contractor

  • Have you returned from any country outside Canada in the last 14 days?

  • Which country(ies)

  • Have you had close contact with or cared for someone with flu like symptoms or diagnosed with COVID-19 during your time off?

  • Have you experienced any cold or flu-like symptoms in the last 14 days (to include fever, cough, sore throat, respiratory illness, difficulty breathing)?

  • Fever

  • Cough

  • Sore Throat

  • respiratory illness

  • Difficulty Breathing

  • Have you wash your hands or used sanitizer when you arrived at the Kananaskis Nordic Spa

  • I confirm all information is true and accurate (Submitted by)

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.