Visitor Screening Form COVID-19

The health and safety of the public and Township employees is important at the Township of North Dumfries. Each visitor is asked to complete this questionnaire regarding their current health before entering a Township facility. The Township's primary goal is to prevent the spread of the COVID-19 virusPlease submit this completed form to Township staff.


If any answer was "YES" or you are experiencing any of the above symptoms, please do not enter the Township facility. Contact Public Health and/or your health care practitioner immediately and seek guidance as to next steps.

Visitors are requested to remember:

  • If any individual develops flu-like symptoms, they must immediately leave the Township facility and self-isolate. Contact Public Health and/or your medical practitioner and seek guidance.
  • If you experience flu-like symptoms within 72 hours of your visit to the Township, you are requested to notify the Township office immediately.
  • In a Township facility or where physical distancing (2 metres) cannot be achieved, Visitors are to wear a non-medical mask. The Township will provide a face covering if you do not possess a mask.
  • At all times while in our facility, members of the Public and Staff are to maintain 2 metres (6 feet) apart.
  • Visitors are to wash their hands with soap & water. Where soap & water are not available, Visitors should use hand sanitizer.
  • Cough or sneeze into your sleeve.

A healthy and safe municipality is everyone’s responsibility. Your active participation and support are vitally important to maintaining and improving health and safety in Township facilities.