Pioneer Ridge Outside Visitor Screening Tool

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

IMPORTANT: General Visitors are restricted at this time. Essential Caregivers and Essential Visitors Only. 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.


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


Attestion of Compliance to Requirements during visit:

I have been informed of the visitor requirements and have reviewed the "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
  • Bring your own mask (must be worn at all times)
  • Physical Distancing of 6 feet between Visitor & Resident must be practiced during the entire visit
  • 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 that non-compliance will result in discontinuation of visits and if physical distancing is not maintained the Resident will be isolated for 14 days and a COVID-19 test completed.

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.

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