NORTH SOUND BH-ASO

COVID-19 VISITOR SELF SCREENING CHECKLIST

The safety of our employees and visitors are our primary concern. As the coronavirus (COVID-19) outbreak continues to evolve and spread globally, North Sound BH-ASO is monitoring the situation closely and will periodically update company guidance on current recommendations from the Center for Disease Control and the World Health Organization.

To help prevent the spread of COVID-19 and reduce the potential risk of exposure to our employees and visitors, we are conducting a simple screening questionnaire. Your participation is important to help us take precautionary measures to protect you and everyone in the building. All items marked with a red asterisk are required. If you prefer to submit a PDF version of this form, download the form here and email the completed form to HR@nsbhaso.org.

Thank you for your time and cooperation.

Please complete the following

If the answer is yes to any of the following questions,
do not visit the North Sound BH-ASO Office.

Self Declaration by Visitor


*Take your temperature immediately before filling out this form.