COVID-19 – Windmill Cabinets

Requested Contact

First Name*

Last Name*

Phone*

Email*

Company / Association

Reason for Contact with Windmill Employee*

Essential Worker
Client
Employee
Other

Other

Please explain your reason for contact

Number of Attendees*

Only 2 people are allowed to attend any appointment excluding Windmill Staff

Date of Appointment

Location*

Showroom
Plant
Offsite

Have you travelled outside of Canada within the last 14 days?*

Yes
No

Have you been in close contact with anyone who has travelled outside of Canada within the last 14 days?*

Yes
No

Have you had close contact with or cared for someone diagnosed with COVID-19 within the last 14 days?*

Yes
No

Do you have respiratory symptoms such as a cough, breathing difficulties or a fever?*

Yes
No

Consent*

I have answered the questions honestly and I understand that if my answer was "yes" to any of the questions above, access to the showroom, facility and/or work site will be postponed or denied.