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Health Questionnaire and Realtor Confirmation
Do you have a fever?:
Yes
No
Do you have a cough, or are you experiencing difficulty breathing or shortness of breath?:
Yes
No
Have you had contact with a person who has a confirmed or suspected case of COVID-19?:
Yes
No
Have you traveled outside of Canada within the past 14 days?:
Yes
No
If you answered "Yes" to any of the questions above, you will not be able to enter this property today. Thank you for your cooperation.
By answering these questions I understand: 1. Any affirmative answer may result in my inability to view a property(ies) for sale. 2. The answers to this questionnaire will be kept on file in the event that a listing agent requests them. 3. The seller’s agent may contact my agent for the sole purpose of informing me in the event any person living in the viewed property(ies) is determined to have been exposed to COVID-19 or if there are any other coronavirus-related developments in connection with the property(ies) that I wish to view. 4. If I am diagnosed with COVID-19 within 14 days of my viewing of the property(ies) for sale, I shall immediately contact my agent to advise them and that they may inform the seller’s listing agent and/or the seller of such diagnosis.:
Yes
No
Property Address:
By answering yes below, I confirm that I have reviewed the 4-question Health Questionnaire with each party that accompanied me to the above-identified property, and that the only parties who entered the house passed the Health Questionnaire (i.e., answered “No” to all four of the questions).:
Yes
No
Realtor Name:
Date:
Email:
Phone Number:
Thank you for your cooperation
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