COVID-19

COVID-19 SCREENING

In accordance with Ontario's COVID-19 Response Framework, bars & restaurants are required to collect contact information from all patrons, and all patrons are required to complete a COVID screening questionnaire.

Effective March 23 2021, only persons who reside at the same address may be seated together, with exceptions for people who live alone but are bubbled with the people at the table, or a caregiver for someone at the table.

By clicking Submit, you are confirming the information on this form is true and accurate.

Name*

Household Declaration*

I live alone and am bubbled with the people at the table.I am the caregiver of a person at the table.I am seated with people who reside at the same address as me, a person who lives alone, or is a caregiver of someone at the table.

Additional Members of Household

Email Address

Phone*

COVID-19 SCREENING QUESTIONNAIRE*

Please check boxes to confirm the following statements:

I/we are not experiencing any symptoms of COVID-19 (such as fever or chills, new or worsening cough, difficulty breathing, sore throat, runny/stuffy nose, loss of taste or smell, nausea, vomiting, diarrhea, abdominal pain, extreme tiredness, sore muscles).I/we have not travelled outside of Canada in the last 14 days.I/we have not had close contact with a confirmed or probable case of COVID-19.

Table Number*

This site uses Google reCAPTCHA technology to fight spam. Your use of reCAPTCHA is subject to Google's Privacy Policy and Terms of Service.

Thank you! Your message was sent successfully.