YCD Visitor Self Assessment

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

Yes
No

Has a member of your household returned from outside of Canada within the last 14 days?*

Yes
No

Have you been in contact with someone who has travelled outside of Canada and who is experiencing symptoms of COVID-19 (Cough, fever, difficulty breathing)?*

Yes
No

If you answered yes to question 1, 2, or 3, you are prohibited from entering any Nanaimo Airport building or facility for 14 days. The 14 days will begin from the day that you returned to Canada or the first day of no longer having contact with a person diagnosed with COVID-19.

Do you have a fever with or without cough or congestion?*

Yes
No

Do you have any signs or symptoms of respiratory or flu-like illness or have had signs or symptoms of COVID-19 in the past 14 days?*

Yes
No

If you answered yes to question 4 or 5, you are prohibited from entering any Nanaimo Airport building or facility. You may return to the site after a 14-day period and when you have been symptom free for at least 72 hours and cleared by your doctor to return to work or normal activities. If you answered no to all questions, please complete and sign this assessment, and give to Nanaimo Airport personnel on arrival.

By signing my name below, I certify this information is accurate and complete.

Name*

First Last

Company Name*

Phone*

Date*

The Nanaimo Airport is committed to keeping our Terminal building safe for all of our staff, tenants and passengers. In order to maintain a safe and healthy environment we ask that all contractors & visitors first fill out a COVID-19 self assessment before coming on site.

If you answered yes to question 1, 2, or 3, you are prohibited from entering any Nanaimo Airport building or facility for 14 days. The 14 days will begin from the day that you returned to Canada or the first day of no longer having contact with a person diagnosed with COVID-19.

By signing my name below, I certify this information is accurate and complete.

PASSENGERS

BUSINESS

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