Covid


𝗧𝗢 𝗔𝗦𝗦𝗜𝗦𝗧 𝗪𝗜𝗧𝗛 𝗖𝗢𝗡𝗧𝗔𝗖𝗧 𝗧𝗥𝗔𝗖𝗜𝗡𝗚 𝗔𝗡𝗗 𝗘𝗡𝗦𝗨𝗥𝗘 𝗕𝗨𝗜𝗟𝗗𝗜𝗡𝗚 𝗖𝗔𝗣𝗔𝗖𝗜𝗧𝗬 𝗟𝗜𝗠𝗜𝗧𝗦 𝗔𝗥𝗘 𝗠𝗔𝗜𝗡𝗧𝗔𝗜𝗡𝗘𝗗 we require that all Clients complete this form EVERY TIME they are coming for a shoot or appointment at a indoor location.


Protection of Privacy - The personal information requested on this document is collected in accordance with the Government of Alberta's public health orders and COVID-19 Information Guidelines and under the authority of sections 33(a) and (c) of the Alberta Freedom of Information and Protection of Privacy Act and will be protected under Part 2 of that Act. The personal information collected will be used for the purpose of reporting regarding attendance at PPOC-AB sanctioned events during the COVID-19 health emergency and may be disclosed to the Government of Alberta and or Alberta Health Services for the purpose of public health management during the COVID-19 pandemic.

Are you feeling unwell or experiencing any symptoms of COVID-19? (Fever. A new cough or a chronic cough that is worsening. New or worsening shortness of breath or difficulty breathing. Sore throat. Runny nose.) *

Have you returned from travel outside of Canada in the last 14 days? *

In the past 14 days, at work or elsewhere, while not wearing appropriate personal protective equipment, have you been in close contact with someone who is confirmed as having COVID-19? * *

In the past 14 days, at work or elsewhere, while not wearing appropriate personal protective equipment, Did you have close contact* with a person who had acute respiratory illness that started within 14 days of their close contact* to someone with a probable** or confirmed case of COVID-19? *

In the past 14 days, at work or elsewhere, while not wearing appropriate personal protective equipment, Did you have close contact* with a person who had acute respiratory illness who returned from travel outside of Canada in the 14 days before they became sick? *

In the past 14 days, at work or elsewhere, while not wearing appropriate personal protective equipment, Did you have a laboratory exposure to biological material (i.e. primary clinical specimens,virus culture isolates) known to contain COVID-19? *

I understand the novel coronavirus (COVID-19) has been declared a worldwide pandemic by the World Health Organization. I further understand that COVID-19 is extremely contagious and is believed to spread by person-to-person contact. As a result, Chief Medical Officers at the Federal and Provincial levels of government in Canada have recommended social distancing. I understand COVID-19 has a long incubation period during which carriers of the virus may not show symptoms and still be contagious. I recognize T