Staff Daily Consent Form During Covid-19 Pandemic

I understand the novel coronavirus causes the disease known as COVID-19.

I understand the novel coronavirus has a long incubation period during which carriers of the virus may not show symptoms and still be contagious.

I understand that dental procedures create water spray which is one way that the novel coronavirus can spread. The ultra-fine nature of the spray can linger in the air for minutes to sometimes hours, which can transmit the novel coronavirus.

I understand that due to the frequency of visits of other staff, dentists and dental patients, the characteristics of the novel coronavirus, and the characteristics of dental procedures, that I have an elevated risk of contracting the novel coronavirus simply by being in a dental office.

I confirm that I am not presenting any of the following symptoms:
• Fever > 37.5 C
• Cough
• Sore Throat
• Shortness of Breath
• Flu-like symptoms
• Runny Nose

I confirm that I have considered if I am in high risk category (factors include; diabetes, cardiovascular disease, hypertension, lung diseases including moderate to severe asthma, being immunocompromised, having active malignancy, age > 65) and have chosen to work.

I confirm that I am not currently positive for the novel coronavirus.

I confirm that I am not waiting for results of a laboratory test for the novel coronavirus.

I verify that I have not returned to British Columbia from any country or any other province in Canada whether by car, air, bus or train in the past 14 days.

I understand that any travel from other provinces or any other country , including travel by car, air, bus or train, significantly increases my risk of contracting and transmitting the novel coronavirus. BC’s Provincial Health Officer requires self-isolation for 14 days from the date a person has returned to Canada.

I understand that BC’s Provincial Health Officer has asked individuals to maintain physical distancing of at least 2 metres (6 feet) and it is not possible to maintain this distance and provide or assist with dental treatment.

I verify that I have not been identified as a close contact of a confirmed case of someone who has tested positive for novel coronavirus and/or been asked to self-isolate by any provincial or federal governmental health agency.