F & P Return to Work Questionnaire
The health and safety of our associates, customers, business partners and the general public is very important to us.
Due to the current Covid-19 pandemic we are increasing our sanitation efforts and are promoting the government recommended prevention techniques to help mitigate the spread of the virus.
A screening process has been implemented including a questionnaire and temperature check prior to entry. Face masks are mandatory and are part of our PPE program.
F&P Mfg. will continue measures with guidance from public health and government organizations during this unprecedented situation.
Download Questionnaire (Word .doc) | Download Questionnaire (PDF)
F&P Manufacturing COVID-19 Screening
Carefully read the following questions and circle the answer that applies
- Have you travelled or been outside of Canada in the last 14 days?
Yes No IF YES DO NOT RETURN TO WORK – CONTACT GINA HOVINGA at x390
- Do you have any of the following symptoms; Fever OR new or existing cough OR difficulty breathing OR shortness of breath?
Yes No IF YES DO NOT RETURN TO WORK – CONTACT GINA HOVINGA at x390
- Are members of your household under quarantine for illness or symptoms of COVID-19?
Yes No IF YES DO NOT RETURN TO WORK – CONTACT GINA HOVINGA at x390
- Have you had close contact with any person who has experienced symptoms consistent with COVID-19 AND is currently in the self-quarantine period, waiting to be tested, or waiting for test results, or confirmed positive for COVID-19?
Yes No IF YES DO NOT RETURN TO WORK – CONTACT GINA HOVINGA at x390
Associate Name (please print): ______________________________
Associate Signature: ______________________________
Temperature (Recorded at F&P) _______________________°C
Note: The information collected on this form will be used to determine your eligibility to enter the F&P Mfg. facility. All information is strictly confidential and is collected for the sole purpose of maintaining F&P Associates’ Health and Safety. It is imperative that all questions be answered truthfully. Any false statements could have detrimental health effects on your fellow associates and their families. Consequences for such behavior will be swift and serious. Help us do the right thing.
