Respiratory Health Questionnaire
If you answer YES to any of the questions below:
1. You must obtain a fitness certificate from a health care provider or your company.
- NOTE: The certificate should clearly indicate, in English, that you are free from any respiratory infectious disease and affirming your fitness to travel for business/work purposes BEFORE you travel to any SNF sites.
2. If you answer YES to either of the last 2 questions below: Before departing for any SNF sites, you will need to:
A. Complete a 14 day self-isolation
B. Obtain a fitness for work certificate from a health care provider or your company
3. You must submit this form and supporting documents to your employer for submission to SNF contact, who will have it reviewed by SNF Medical personnel.