Callingwood Square Shopping Centre
6643-177 Street, Edmonton, Alberta T5T 4K3
Phone: (780) 483-1338 Fax: (780) 483-1393
Email: info@edxi.com Website: www.edxi.com

COVID-19 Pre-Screening Form


I understand the novel coronavirus causes the disease known as COVID-19. I understand the novel coronavirus virus has a long incubation period during which carriers of the virus may not show symptoms and still be contagious.

I confirm that I am not presenting any of the following symptoms of COVID-19 identified by Alberta Health Services:

OR

Callingwood Square Shopping Centre
6643-177 Street, Edmonton, Alberta T5T 4K3
Phone: (780) 483-1338 Fax: (780) 483-1393
Email: info@edxi.com Website: www.edxi.com