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COVID-19 Screening For Employees

Dear employees of Golden Trim, please fill in and submit the following COVID-19 screening form.

If you answer YES to any questions, then please go home or stay home, and self-isolate. Go to the BC Covid-19 self-assessment tool @ bc.thrive.health/covid19/en to learn more about the next step to take.

Name of Employee *

Have you traveled outside of Canada in the last 14 days? *

Yes
No

Has someone you are in close contact with tested positive for Covid-19 In the last 14 days? *

Yes
No

Are you in close contact with a person who is sick with new respiratory symptoms or who recently traveled outside of Canada? *

Yes
No

Do you have a fever? (temperature ≥ 37.8 °C) T° *

Yes
No

Do you have chills? *

Yes
No

Do you have a new or worsening cough (dry or productive)? *

Yes
No

Do you have shortness of breath or difficulty breathing? *

Yes
No

Do you have a sore throat or difficulty swallowing? *

Yes
No

Do you have a loss of taste or smell? *

Yes
No

Do you have a headache that is unusual or long-lasting? *

Yes
No

Do you have a runny or stuffy nose? (not related to seasonal allergies or other known causes or conditions) *

Yes
No

Do you have nausea, vomiting, diarrhea or abdominal pain? *

Yes
No

Do you have muscle aches or unexplained fatigue? *

Yes
No

Do you have any other symptoms not listed above? *

Yes
No

If you answered Yes to other symptoms, then please list those symptoms.

If you answered YES to any questions, then please go home or stay home, and self-isolate. Go to the BC Covid-19 self-assessment tool @ bc.thrive.health/covid19/en to learn more about the next step to take.

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Richmond: 604-231-8120
Burnaby: 604-421-3998
COVID-19 Notice

Decorative Wall Panels

Eco-Friendly Flooring

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Engineered Hardwood

ter Hürne
ETM Signature Brushed
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Preverco Solid

Premium Laminate

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Waterproof O.R.C.A. Board

EUROSTYLE Organic
Organic Clever Long Silent

Waterproof Vinyl

ETM Venice Ultracore
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Richmond 604-231-8120
Burnaby 604-421-3998

Golden Trim Hardwood, Laminate & Vinyl Plank Flooring Store serves Metro Vancouver including Abbotsford, Aldergrove, Burnaby, Coquitlam, Cloverdale, Delta, Fort Langley, Ladner, Langley, Maple Ridge, New Westminster, North Vancouver, Pitt Meadows, Port Coquitlam, Port Moody, Richmond, Surrey, Tsawwassen, Vancouver, West Vancouver, Whistler and White Rock, British Columbia, Canada.

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