YCD Visitor/Contractor Self Assessment

Are you required to isolate as per Health guidelines as as result of travel outside of Canada ( or province where applicable)?*

Have you been advised to isolate as per Public Health?*

Does a member of your household have, is believed to have or is being tested for COVID-19? ?*

Do you have any flu or COVID-19 symptoms?*

Have you tested positive or are waiting for COVID-19 test results and have been advised to isolate?*

If you answered yes to any of these question you are prohibited from entering any Nanaimo Airport building or facility.

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

Name*

First Last

Company Name*

Phone*

Date*