COVID Form

First Name

Last Name

Phone Number

Project

Have I returned from a trip outside of Canada in the last 14 days?

YES NO

Am I currently experiencing any of the following symptoms:

Fever or chills?

YES NO

A sudden loss of smell without nasal congestion (stuffy nose) with or without loss of taste?

YES NO

A recent cough or a recently worsened chronic cough?

YES NO

Difficulty breathing or shortness of breath?

YES NO

Sore throat?

YES NO

Runny nose or nasal congestion (stuffy nose) of unknown cause?

YES NO

Have I been in close contact* or lived with with a confirmed COVID-19 case in the last 14 days?
Close contact: Worker who has been, WITHOUT any protective equipment, within 2 meters of a confirmed COVID-19 case for more than 15 cumulative minutes within 48 hours prior to the onset of symptoms or prior to departure in isolation of the case (examples: unprotected carpooling, unprotected work contact or social contact).

YES NO

Do I have one of the following symptoms:

Unusual intense fatigue for no obvious reason?

YES NO

Generalized muscle pain or aches (non related to physical effort)?

YES NO

Nausea or vomiting?

YES NO

Diarrhea?

YES NO

Unusual headache?

YES NO

Unusual loss of appetite?

YES NO

Stomach ache?

YES NO

Have I tested positive for COVID-19 in the past 14 days?

YES NO

We are groupe gi2

We are a company specializing in hospitality and commercial design and construction with a strong presence in the residential sector.

69 Chemin Bates, Outremont, Québec, H2V 1A6
[email protected]
Visa & MasterCard payments accepted