COVID-19 Customer Safety Visit Questionnaire

Please advise us if you require a mask while we are at your home and we will provide a disposal mask for one person if required.

When we arrive, we will call you from your driveway so you can prepare the entry way to the furnace room and turn on the lights for us while maintaining a 2 metre distance at all times.

It is your responsibility to inform Unionville Heating if any of the questionnaire answers change between the time completing the  questionnaire  and the time of service.

Please complete the following before your service appointment with Unionville Heating Staff.

The purpose of the questionnaire is to follow the Health Canada guidelines and Ontario Health for COVID-19 Contact Tracing.  We want to make sure you and our staff are safe.  If you could please take a moment to fill this out?

House Number and Street Address where the work is performed:

Has anyone in your home or visited your home been out of the country in the last 14 days?
yesno

Is anyone in your home sick?
yesno

Have you been in isolation for at least 14 days?
yesno

We have a physical distancing policy for your safety and our staff safety, will you respect physical distancing with our staff is in your home?
yesno

Has anyone in the house been in close contact with anyone who has tested positive for COVID-19?
yesno

By checking this box I acknowledge that I have read, understand and agree.

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