Clinic Sign In & Disinfectant Log
*
1.
Date
(Required.)
*
2.
Time Clinic Space Accessed (Arrival to Departure Time)
(Required.)
*
3.
Name of Person Completing Log
(Required.)
*
4.
Name of Person(s) Accessing Clinic (EMLG Team Member, Client, Client Caregiver, etc)
(Required.)
*
5.
Clinic Space Accessed
(Required.)
Collingwood Clinic Office
Collingwood Clinic Senior ABA Room
Collingwood Clinic Junior ABA Room
Newmarket Clinic Office Room
Newmarket Clinic OT Room
Newmarket Clinic Counseling Room
Newmarket Clinic Senior ABA Room
Newmarket Clinic Junior ABA Room
*
6.
I verify that the space that was accessed by the above listed persons, was disinfected using the Vital Oxide Fogger
DIN #02422654
folllowing their departure in line with the policies and procedures laid out by Engaging Minds Learning Group Inc and in accordance with the Public Health Measures in the service areas for Engaging Minds Learning Group Inc.
(Required.)
Yes
Current Progress,
0 of 6 answered
