I certify that

• I have not tested positive or tested positive for Covid-19 in the past 14 days.
• I have not had residential contact with people arriving from abroad in the past 14 days.
• I have not had home contact with people showing symptoms or who have tested positive for Covid-19 in the past 14 days.
• I am not experiencing symptoms of Covid-19 (fever, cough, breathing problems, loss of taste, loss of smell).

In compliance with the health rules concerning Covid-19, you may not be authorized to work on this mandate if you are at risk. Note that we encourage all applicants to provide us with proof of a negative Covid-19 result before the start of their term.

In the event that I begin to present one of the symptoms mentioned above once at the place of the contract or in any related establishment, I undertake to immediately notify my supervisor or a manager and I agree to suspend my contract immediately for a return home. I agree to provide proof of a negative Covid-19 test result so that I can return to the contract premises.

This statement is confidential. However, I consent to Staff Renter communicating certain information collected to the competent authorities if necessary.

I have read the health measures and understand that these measures are put in place to protect the health and safety of all. As zero risk does not exist, I also understand that despite the measures put in place, there is still a risk of contacting Covid-19.

I undertake to abide by these measures as well as all directives from government authorities in the matter and I accept the risk involved in working on this mandate.

I acknowledge by accepting the terms of this form that accepting the terms electronically has the same status as a manual signature.