COVID-19 VISITOR PRE-SCREENING QUESTIONNAIRE

On March 11, 2021 the Simcoe Muskoka District Health Unit (SMDHU) issued a letter of instruction to all businesses, which included various Instructions for Additional Public Health Measures in the City of Orillia. Included in the Instruction from SMDHU is the requirement for COVID-19 pre-screening of all visitors before attending an appointment at a business that is permitted to be open by appointment only. If a visitor does not pass the assessment, he/she must stay home. Crate’s is conducting active visitor pre-screening using the questionnaire on this page.

  • Pre-screening questionnaires must be completed on the day of your appointment, before you come to Crate’s
  • A maximum of 2 persons living at the same household may attend an appointment at Crate’s
  • Every visitor who is 18 years of age or older must complete his/her own Pre-Screening Questionnaire
  • Where a person under the age of 18 is visiting Crate’s with a parent or guardian, the parent or guardian may complete the questionnaire on behalf of the minor

BEFORE COMING TO CRATE’S FOR AN APPOINTMENT, EVERY VISITOR MUST COMPLETE THIS QUESTIONNAIRE


Questionnaire

(1)     Do you have any of the following symptoms?

  • fever and/or chills (feeling hot to the touch, a temperature of 37.8 degrees Celsius or higher)
  • cough that's new or worsening (more than usual and not related to asthma or other known condition)
  • barking cough, making a whistling noise when breathing (croup)
  • shortness of breath (out of breath, unable to breathe deeply)
  • sore throat (not related to acid reflux, seasonal allergies or other known condition)
  • difficulty swallowing
  • runny, stuffy or congested nose (not related to seasonal allergies or other known condition)
  • lost or decreased sense of taste or smell
  • pink eye (conjunctivitis, not related to reoccurring styes or other known condition)
  • headache that’s unusual or long lasting
  • digestive issues (nausea/vomiting, diarrhea, stomach pain, not related to other known condition)
  • muscle aches (not related to sudden injury or other known condition)
  • extreme tiredness that is unusual (fatigue, lack of energy, not related to other known condition)
  • falling down often (for older people)

(2)     Has a doctor, health care provider, or public health unit told you that you should currently be isolating at home?


(3)     In the last 14 days, have you been identified as a “close contact” of someone who currently has COVID-19?


(4)     In the last 14 days, have you received a COVID Alert exposure notification on your cell phone? (If you already went for a test and got a negative result, select “No.”)


(5)     In the last 14 days have you or anyone living in your household travelled outside Canada?


(6)     Is anyone living in your household currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms?



NO > If you answered “no” to all questions, sign below to self-certify that you are clear for your appointment.

YES > If you answered “yes” to any questions your appointment will be cancelled. Stay home, self-isolate and contact your healthcare provider or Telehealth Ontario (1-866-797-0000).



Who are you Visiting? *

Please Select
Your Name *
Your Email *
Your Phone *


I hereby certify that I have answered “no” to all of the questions above




Submit Your Covid Questionnaire



When You Arrive

  • Park in the designated Customer Parking area in front of our office. Stay in your car and call 705-327-9741 to let us know you are here.
  • We will meet you at your car with disposable face masks and gloves, if you do not have your own.
  • Show Crate’s staff member your email confirmation with green “You can go” result
  • You will be directed to enter our reception area, apply alcohol-based hand sanitizer, have your temperature taken using our non-contact thermometer and sign in with our log book.
  • Ensure you wear your mask and maintain 2M physical distance at all times while at Crate’s.
  • Don gloves prior to boarding any vessel.
  • Observe all COVID-19 signage throughout the property and follow staff directions.

What You Can Expect from Us

  • A maximum of 2 customers will be permitted inside Crate's facilities at any given time - exceptions may be made for more than 2, provided all persons live in the same household.
  • When your temperature reading is taken at Crate’s, your photograph will be digitally recorded and date-stamped by the thermometer.
  • This information will be stored securely for the purpose of contact tracing.
  • Your Crate’s representative will be wearing a face mask at all times, as well as gloves while onboard any boat.


Covid-19: What to Expect When Visiting Crate’s      Learn More