At Keystone Environmental we are committed to the health and safety of our employees and to the adherence of Provincial Health Orders.  As such, this questionnaire must be completed and submitted daily – unless you are planning to work from home.


Please complete and submit this questionnaire daily prior to attending work.

Important: Action required as a result of wellness questionnaire:

  • If you answer no to all the below questions, you are approved to go to the office/work site.
  • If you answer yes to any of the below questions, you must stay home, notify your team leader or Project Manager, and contact 8-1-1 to find out if you need a COVID-19 test.

COVID-19 Daily Wellness Questionnaire

a. Fever and/or chills

b. Difficulty breathing or shortness of breath

c. Cough or sore throat

d. Loss of smell or taste

e. Extreme fatigue/sore muscles

2. Have you or anyone in our household had close contact with a person who has a confirmed or presumptive case of COVID 19?

3. Have you, or someone in your household travelled outside of Canada in the last 14 days?

7 + 1 =

By submitting this form, you are consenting to the collection of personal information by Keystone Environmental.  This information is being collected to ensure the health and safety of our employees and to comply with the recommendations of the Provincial Health Officer (PHO) to protect against the spread of COVID-19.  This information will be collected by Human Resources and may be reviewed by the applicable team leader and/or project manager. It will not be disclosed to any third party without your consent other than to the PHO upon request for contact tracing purposes.

Our Office

320-4400 Dominion Street
Burnaby, BC V5G 4G3

Contact Us

(604) 430-0671 

Office Hours

Mon-Fri: 8am – 5pm
Sat-Sun: Closed

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