Pioneer Ridge Inside Visitor Screening Tool

NOTE: This tool is for visiting Pioneer Ridge Residents INSIDE. If you have scheduled an OUTSIDE visit, please use the Outside Visitor Screening tool.

IMPORTANT: General Visitors are restricted at this time. Essential Caregivers and Essential Visitors Only.  Essential Caregivers and Essential Visitors must be tested for Covid-19 weekly. Testing is available in the Pioneer Ridge Classroom Monday through Wednesday from 8-4pm. If you cannot make it in for testing on one of the designated days, please contact the Director of Nursing or Clinical Manager who will set up a suitable time for you.

Please call 684-3956 to schedule your window or virtual visit. The screening must be completed the day of the visit and no earlier.

Please complete all questions and submit your results. Thank you for your co-operation.

PART I

Do you have any of the following symptoms:

• Fever (feeling hot to the touch, a temperature of 37.8 degrees Celsius or higher)
• New or worsening cough
• Shortness of breath
• Sore throat
• Runny nose or sneezing
• Nasal congestion
• Hoarse voice
• Difficulty swallowing
• New smell or taste disorder(s)
• Nausea/vomiting, diarrhea, abdominal pain
• Unexplained fatigue/malaise
• Chills
• Headache

PART II

1. Attestion of Compliance to Requirements during visit:

I have been informed of the visitor requirements and have reviewed the "INSIDE Family Visit Reminders":

• Arrive no earlier than 15 minutes prior to scheduled time
• Proceed to the “Screening Table” at the Family Visiting Area near our main entrance (during inclement weather we will be located in the vestibule of the front entrance)
• A procedural mask will be provided and must be worn at all times
• No pets or outside drink or food for the Resident is allowed
• Please leave any items for your family member at the table located at our Staff entrance (Mondays – Fridays 9 am – 3 pm)

I understand:

• I must proceed directly to and from the resident's room
• There is no access to any common areas of Pioneer Ridge
• Infection, prevention and control (IPAC) protocols must be followed at all times, including wearing a procedure mask and sanitizing my hands before and after entering the building and the resident room
• Non-compliance of these requirements will results in the discontinuation of visits

2. Attestion of negative COVID-19 test:

I attest to Pioneer Ridge screening staff that I have tested negative for COVID-19 within the last 2 weeks of today's date and subsequently not tested positive.

Any collection of personal information is made under the authority of the Ministry of Health Guidance Document: Section 77.7 of the Health Protection and Promotion Act (HPPA), R.S.O. 1990, c. H.7. Personal information is collected in compliance with the Municipal Freedom of Information and Protection of Privacy Act.

Personal information is collected for the purpose of complying with provincial orders related to the COVID-19 pandemic.  None of your personal information will be shared, rented, sold or otherwise released to any third party without your consent. 

Any questions about this collection should be directed to: Linda Pauluik.