Re-entry to Workplace Questionnaire



We require you to fill out the below questionnaire to assist in determining your fitness to return to the work office during the COVID-19 pandemic to provide a safe environment for all staff and clients. The information in this questionnaire is collected and will be used and disclosed solely for the purposes of determining fitness to return to work during the COVID-19 pandemic.

You will be required to resubmit this questionnaire should your conditions change.

Section 1 - Employee Information

Ensure the entered e-mail is correct

Section 2 - Questionnaire