Diamondview Photography has implemented a self assessment screening (based on criteria from Ontario's screening tool) to assist in stopping the spread of infectious diseases to our clients and to our family. The health and safety of our clients is of utmost importance, therefore please complete and sign the form below. Your photographer and any participating photography assistants will be self-assessing before the session as well. This assessment must be completed by all people participating - you may choose to complete one form per family, or individual members can fill out their own form.
PLEASE DO NOT FILL OUT THIS ASSESSMENT UNTIL 3 HOURS BEFORE YOUR SCHEDULED SESSION OR APPOINTMENT TIME.
Your first & last name:
What is your session or appointment date:
If there are others in your party that are attending the session, they must either fill out their own assessment form, OR you can include them on your form here. Bottom line, everyone attending the session, whether or not they are being photographed, must go through the self-assessment prior to the session.
Please select:
If there are others in your party that are attending the session they must fill out a form as well, OR you can include them on your form so select the other option above.
If you are including other members in your assessment:
Please list the first and last name(s) of anyone else in your party that will be attending the session, whether they will be photographed or not:
Are you currently experiencing any of these symptoms?
Choose any/all that are new, worsening, and not related to other known causes or conditions you already have.
Is anyone you live with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms?
If the person got a COVID-19 vaccine in the last 48 hours and is experiencing a mild headache, fatigue, muscle aches, and/or joint pain that only began after vaccination, select “No.”
In the last 14 days, have you travelled outside of Canada?
In the last 14 days, have you been identified as a “close contact” of someone who currently has COVID-19?
Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)?
This can be because of an outbreak, contact tracing, or after testing positive on a rapid antigen test.
In the last 14 days, have you received a COVID Alert exposure notification on your cell phone?
Notes:
I agree to disclose any known-to-me information to the Photographer about my health or the health of anyone in my party that could negatively affect the session or the health of the Photographer. I hereby declare that the information provided in this questionnaire is true and correct on behalf of myself and any/all participants that are included in this assessment for my upcoming session.
Type your name to sign:
