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As of September 22, 2021, proof of vaccination will be required to access certain public settings and facilities.

Let’s keep everyone safe

The safety of employees, residents and visitors are of upmost importance at the Municipality of West Nipissing. We are continually monitoring and adapting to public health guidelines in an effort to reduce the spread of COVID-19. In doing our part to provide a safe and healthy workplace, we require all employees to complete this daily screening prior to entering the workplace. Your honest answers will help us keep everyone safe

Some questions and criteria on this form were updated on July 7, 2021.


  • MM slash DD slash YYYY
  • If you received a COVID-19 vaccination within the last 48 hours and are experiencing mild headache, mild muscle aches/joint pain, or mild fatigue, select ‘No’.
  • If you are fully-vaccinated, select ‘No’. If the individual experiencing symptoms received a COVID-19 vaccination in the last 48 hours and is experiencing mild headache, fatigue, muscle aches, and/or joint pain that only began after vaccination, select ‘No’.
  • If you are fully vaccinated and have not been advised to self-isolate by public health, select ‘No’.
  • If you are fully vaccinated and/or have already gone for a test and got a negative result, select ‘No’.
  • This field is for validation purposes and should be left unchanged.

Personal information on this form is collected in accordance with the Municipal Freedom of Information and Protection of Privacy Act. It is to be used for the purpose of administering health and safety precautions within municipal facilities.

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