* Required Field
Please indicate the type and location of the problem/repair you are reporting. If the problem is related to appliances’, please indicate the make, model and serial number of the appliance (contact the office where to locate this information).
*Please check one: RoutineUrgentEmergency
Permission to enter
Yes, Maint/Contractors/Office may enter my unit (with master key) to fix the problemNo, Provide three (3) dates/times that the Co-op may schedule the work.
*Alarm System YesNo
Please answer the following questions
*Are you, or is anyone in your household, experiencing a fever? YesNo
*Are you, or is anyone in your household, experiencing any abnormal or unusual conditions (not associated with allergies, smokers cough, other known respiratory complaints, etc.):
—Please choose an option—No SymptomsCoughingSneezingSore ThroatDifficulty Breathing
*Has anyone in your household traveled outside Canada within the last 14 days? YesNo
*Has anyone in your household had close contact with a person with COVID-19 (probable or confirmed) while they were ill within the last 14 days? YesNo
*Has anyone in your household had close contact with a person who traveled outside of Canada in the last 14 days who has become ill (cough, fever, sneezing, or sore throat)? YesNo
If you have answered “yes” to any of the questions above, Maintenance or the Contractor will not enter your unit until it is confirmed to be safe to do so unless the matter requires immediate attention.
You will be provided with written “Notice of Entry” advising the date the Maintenance or Contractor that will be accessing your unit to complete the necessary repairs, except in the case of urgent maintenance issues where Maintenance will contact you to coordinate entry.
By my signature (name) below I acknowledge that I am required to ensure the Co-op is able to access its units to complete maintenance and that such access is governed by the Co-op’s Occupancy By-law.