Scarfone Hawkins LLP COVID-19 Acknowledgement and Confirmation

Scarfone Hawkins LLP (“Scarfone Hawkins”) is committed to the health and safety of its members including its partners, employees, contractors, and student-interns. It is also driven to provide a welcoming environment for its clients and suppliers.

Accordingly, in light of the recent developments in Ontario regarding the spread of COVID-19, it is mandatory that any individual entering Scarfone Hawkins’ premises complete the below Acknowledgement and Confirmation form to his or her best knowledge and belief.

Acknowledgement and Confirmation

If you are unable to confirm each of the foregoing (now or at any time prior to my return to the Scarfone Hawkins premises), please advise Human Resources and do not attend Scarfone Hawkins’ premises.

Your entry is conditional upon you agreeing to adhere and follow all safety protocols administered by Scarfone Hawkins at all times while on the premises.

If you have any concerns regarding with any health and safety protocols because of a disability, you agree to advise Human Resources, immediately.

First Name

Last Name

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I do not have any of the symptoms identified by the Government of Ontario of Canada as being related to COVID-19.

In the last 14 days I have not travelled outside of Canada and advised to quarantine as per the federal quarantine requirements.

I have not been advised or instructed by a doctor, health care provider, or public health unit that I should currently be isolating (staying at home).

I have not been identified as a “close contact” of someone who currently has COVID-19 within the last 10 days, and have not been advised by public health that I need to self-isolate.

I have not received a COVID Alert exposure notification on my cell phone within the last 10 days, or, I have received a COVID Alert exposure notification on my cell phone within the last 10 days and I have PCR tested for COVID-19 and received a negative test result.

I have not tested positive on a rapid antigen test or a home-based self-testing kit, or, I have tested positive on a rapid antigen test, and have since PCR tested for COVID-19 and received a negative test result, concluding that the positive rapid test was a false positive.

No one in my household is currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms.

COVID-19 Symptoms:

Thank You! Your form has been submitted!Your health and safety is our number one priority!Have a great day!