COVID-19 Screening – Dufferin Windows Limited

For the safety of our staff and clients, we ask that you fill out the form below before we come to your measure or service appointment.

Have you or any members of your household travelled outside of Canada in the past 14 days? (required)
YesNo

Have you or any members of your household tested positive for COVID-19 or had close contact with a confirmed or probable case of COVID-19? (required)
YesNo

Do you or any members of your household have any of the following symptoms: *fever *new onset of cough *worsening chronic cough *shortness of breath *difficulty breathing *sore throat *difficulty swallowing *decrease or loss of sense of taste or smell *chills *headaches, *unexplained fatigue/malaise/muscle aches *diarrhea, abdominal pain, or nausea/vomiting *pink eye (conjunctivitis) *runny nose/nasal congestion without other known cause? (required)
YesNo

If you have answered "YES" to any of these questions, our office will be in contact with you to set up a new measure/service date.

I acknowledge that the information provided above is correct. (required)