Online Work Order Form *Required Fields Please check one EmergencyUrgentRoutine If provided with materials, are you able to do this work yourself? YesNoWill Assist Is this Work Order related to Member Imposed Damage? YesNo I hereby authorize a member of the Maintenance Committee, or a Contractor hired by them, to enter my unit to carry out these repairs or an examination, in the event that I am not home. YesNo Do you have pets? YesNo Note: In the event that you are not home, please make arrangements to have your pet(s) contained away from the Maintenance work space. Your co-operation is appreciated! Covid-19 Questionnaire: Do you have any of the following (new or worsening): Fever - YesNo Cough - YesNo Difficulty Breathing - YesNo Sore Throat - YesNo Runny Nose - YesNo Loss of Taste or Smell - YesNo Not Feeling Well - YesNo Nausea, Vomiting, Diarrhea - YesNo Have you been in close contact with someone who has confirmed COVID-19 in the past 14 days without wearing appropriate PPE - YesNo Have you returned from travel outside Canada in the past 14 days -YesNo IF ANYONE IN YOUR HOUSEHOLD IS EXHIBITING ANY OF THESE SYMPTOMS OR HAS RECENTLY TRAVELED OUTSIDE OF CANADA YOU MUST NOTIFY THE CO-OP MANAGEMENT OFFICE. By placing my name in the signature field below, I acknowledge this does represent my true and valid signature.