Building Access Control (COVID-19)

By submitting this form I confirm that: 1. I have not been diagnosed with COVID-19 in the last 14 days. 2. In the last 14 days I have not been in contact with anyone who has been diagnosed with COVID19 or who is isolating because of the symptoms indicative of COVID-19. This does not apply if you have been in contact with a COVID-positive patient in your capacity as a healthcare worker wearing appropriate PPE. 3. Within the last 14 days I have not experienced any of the symptoms associated with COVID-19 (difficulty breathing, cough, fever, loss of taste or smell). For full list of symptoms visit: https://www.mcgill.ca/coronavirus/resources/health-guidelines#home 4. I am aware of the physical distancing guidelines published by McGill (Details can be found in the following document: Preventing the Spread of COVID-19 https://www.mcgill.ca/coronavirus/resources/directives-preventing-spread-covid-19-campus Be advised that: o All individuals (McGill staff/students and external vendors) will be screened at the entrance by Security. PROOF OF VACCINATION (QR Code) and ID must be shown before accessing the building. o Procedure Masks are mandatory at the Neuro. Face shields are optional. o A distance of at least 2 m to others must be maintained at all times. o High touch surfaces and shared tools have to be cleaned after use. Thank you, Facilities.Neuro@mcgill.ca Ext. 4481

REQUESTOR

Name

Only use the following domains: @mcgill.ca, @mail.mcgill.ca or @muhc.mcgill.ca. All other domains will not be accepted.

Phone number

Please provide complete number with area code.

Research Unit/Group

PI/Supervisor Email

Your PI/Supervisor will get an automatic notification for this request.

LOCATION

Room(s) to be Accessed

For North Wing: NW### For North Wing Basement: NWB### For Webster: W### For Webster Basement: WB### For Molson: MP### For BTRC: BT### If more than one, separate them with a comma. Indicate if in 527 Pine or 3661 University.

Room Function

REQUEST

Essential Service being requested

Project Name (If applicable)

Select from dropdown menu or type your Project Name.

Request Description

Enter a short description or details of your request. If you are Staff/Student and will be picking up things from the Neuro, please specify what items you will be picking up.

GRANT ACCESS TO THE FOLLOWING:

All McGill Staff/Students entering the Neuro must show a valid McGill or MUHC ID. External vendors must be in the List provided by Facilities to access the Neuro and will be given a Visitor's Badge at the Security Desk.

Vendor/Staff Name

Vendor/Staff Cellphone

Please provide complete number with area code.

Company Name

Select from dropdown menu or type the Company Name or Firm. If you are Staff, type N/A.

Access Date & Time/Period

Comments

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