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COVID-19 Screener Form for Staff, Clients and Volunteers

Please note to all staff, clients, and volunteers:

Before entering WOCRC – 2 MacNeil Court, you must fill out the attached form and return the completed version to your supervisor.

  • To download the form, click on the image below or click here for the 18 and older form
  • To download the form, click on the image below or click here for the under 18 form
  • The form will appear on your screen
  • Right-click with your mouse and select “Save as” OR hover over the form and click “download” from the bar that appears at the top
  • You can choose to rename the file if you wish
  • Click Save
  • Open the form using a program such as Adobe Reader or Adobe Acrobat
  • Fill in the form and save it
  • Send it to your supervisor via email

IF USING A SMARTPHONE: Please be sure to download the Adobe Reader app (FREE) on iOS or Android before filling out the form below.

COVID Screener ENG 18 and older

COVID Screener ENG under 18

Thank you