Return to Work - The Quantum Group

URL

This field is for validation purposes and should be left unchanged.

IN THE PAST WEEK HAVE YOU:

Felt generally unwell, or experienced cold or flu-like symptoms?*

Yes
No

Been tested for COVID-19?*

Yes
No

Been caring for, or in close contact with anyone experiencing the signs or symptoms of COVID-19, or other flu-like symptoms?*

Yes
No

Been in contact with anyone who has tested positive or is under quarantine for COVID-19?*

Yes
No

Been in close contact with an essential worker who feels they were exposed to COVID-19?*

Yes
No

Returned from travel internationally or from a region impacted severely by COVID-19 (e.g. NYC, Seattle)?*

Yes
No

Visited a group care facility (e.g. elderly assisted living home) or prison?*

Yes
No

Name*

Email*

Confirmation:*

By checking this box you consent to the following:

I confirm that my response is correct and complete to the best of my knowledge, and agree to abide by the social distancing and safety measures currently in effect in the Quantum office.

COVID-19
PRESCREENING

COVID-19
PRESCREENING

IN THE PAST WEEK HAVE YOU:

CONTACT US

CONNECT WITH QUANTUM

COVID-19PRESCREENING

COVID-19PRESCREENING

IN THE PAST WEEK HAVE YOU:

COVID-19
PRESCREENING

COVID-19
PRESCREENING