FORM B
COVID-19 PANDEMIC Seller Occupant Showing Health Disclosure Declaration Prior to allowing in-person viewings of your property, please consider the health and safety of others.
Listing Sales Representative/Broker: _________________________________ Premise Address: ____________________________ on Date: ____________ and Time: _____________ Check boxes to be completed if Listing Representative is to facilitate in-person form completion OR be in attendance at property showing. I confirm the following statements to be true (check all that apply): □ I have not recently travelled anywhere outside of Canada or been in contact with anyone who has travelled outside of Canada. □ I have not experienced any of the following symptoms in the last 14 days: fever, dry cough, shortness of breath, or difficulty breathing. □ I have not come into contact with anyone with a confirmed COVID-19 diagnosis in the last 14 days. Health Declaration By Contracted Selling Party #1 (please print): Name: ___________________________________________ I confirm the following statements to be true of ALL premise occupants (check all that apply): □ No one residing in the premise has recently travelled anywhere outside of Canada or been in contact with anyone who has travelled outside of Canada. □ No one residing in the premise has experienced any of the following symptoms in the last 14 days: fever, dry cough, shortness of breath, or difficulty breathing. □ No one residing in the premise has come into contact with anyone with a confirmed COVID-19 diagnosis in the last 14 days. Health Declaration By Contracted Selling Party #2 (please print): Name: ___________________________________________ I confirm the following statements to be true of ALL premise occupants (check all that apply): □ No one residing in the premise has recently travelled anywhere outside of Canada or been in contact with anyone who has travelled outside of Canada. □ No one residing in the premise has experienced any of the following symptoms in the last 14 days: fever, dry cough, shortness of breath, or difficulty breathing. □ No one residing in the premise has come into contact with anyone with a confirmed COVID-19 diagnosis in the last 14 days. NOTE: Access to this property will not be granted for any Buyer Prospect(s) or their Realtor without all contracted Seller(s) completing this declaration, OR if any contracted Seller party has been unable to check all of the above 3 criteria. ALSO, a declaration of good health must be completed by any interested Buyer Prospect and their Realtor, with all health criteria being checked. The completion of a second form is required in cases where there are more than two Sellers on the Listing Agreement.
REALTOR: Please email completed form to COVID-19 Pandemic Seller Health Disclosure v1 April 3 2020