Maintenance Request

Have you or anyone in your household experienced any cold or flu-like symptoms in the last 14 days (including fever, cough, sore throat, respiratory illness, difficulty breathing)?

Yes No

Have you or anyone in your household travelled outside of Canada in the last 14 days?

Yes No

Have you or anyone in your household been in close contact with or cared for someone diagnosed with COVID-19 within the last 14 days?

Yes No

Have you or anyone in your household been in contact with anyone who has travelled outside of Canada within the last 14 days?

Yes No

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Maintenance Request

Maintenance Request

First Name

Last Name

Address

Email

Phone

Description of Issue

Do we have permission to enter your unit to complete the requested work?

Do You Have Any Pets? Please explain

COVID-19 Screening Tool

AON Inc.