Welcome to the staff and visitor self-screening tool at Alzheimer Society. Please Note: All staff and visitors must:
Wear a mask covering your chin, mouth and nose
Keep a distance of 6 feet from others when possible
Wash or sanitize your hands frequently
Follow all instructions provided by ASP staff for the safety of everyone at our sites and within the community
In accordance with Directive #2 for Health Care Providers issued under s. 77.7 of the Health Protection and Promotion Act (HPPA), Alzheimer Society Peel requires all individuals entering any sites to complete the following screening questionnaire in order to manage and monitor COVID-19 infections at all ASP sites, and specifically:
Identify individuals who are at risk of testing positive for COVID-19;
Enhance Alzheimer Society Peel's ability to efficiently screen at all ASP sites;
Plan, evaluate and identify the effectiveness of the questionnaire.
By completing the screening, you are attesting that the information given in the form is true and accurate and agree that the information may be used at a later time for the purposes above. Please note the information collected is not stored or retained by ASP, and it is not linked to your medical record in any way. This information is used to facilitate a one-time entrance. If you have any questions regarding the collection and use of this information, contact the Privacy Officer at s.melnyk@alzheimerpeel.com
By continuing you accept the terms outlined above
