covid - Carolina Fireplace

OUR COVID POLICY
Thank you for supporting our locally-owned small business during this challenging time!
Non-essential in-home services to occupied dwellings are suspended. Warranty repairs and new installation start-ups are scheduled to begin October 15. Our showroom is open for virtual appointments and telephone contact. In-person visits are by appointment only.

Confirm My Appointment

CUSTOMER COVID-19 SCREENING QUESTIONNAIRE

Masks must be worn by all persons present in the home at the time of service as well as the service technician, and a distance of 6’ maintained at all times. We cannot allow any exceptions to this policy, and ask that any person unable to wear a mask remain outside the home during service.

The safety of our customers and employees is our overriding priority. As the coronavirus (COVID-19) pandemic continues, we are monitoring the situation closely and following the guidance from the Centers for Disease Control and Prevention and local health authorities. In order to prevent the spread of the coronavirus and reduce the potential risk of exposure to both customers and employees, completion of this questionnaire is required within the 24-hour window preceding your service appointment.

I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing.

I further acknowledge that Carolina Fireplace & Grill, Inc. and Carolina Fireplace Distributors, Inc. (Further identified as "Contractor") have put in place preventative measures to reduce the spread of the Coronavirus/COVID-19.

I further acknowledge that Contractor cannot guarantee that I will not become infected with the Coronavirus/COVID-19. I understand that Contractor cannot be held liable for any exposure to Coronavirus/COVID-19 caused by misinformation on this form or the health history provided by each client.

Name:

Address:

Builder (new construction start-ups only):

2) In the past 14 days, have you or anyone residing in your home been in close proximity to anyone who was experiencing any of the above symptoms or has experienced any of the above symptoms since your contact?

Yes

3) In the past 14 days, have you or anyone residing in your home been in close proximity to anyone who has tested positive for COVID-19?

Yes

4) Have you or anyone residing in your home been tested for COVID-19 and are waiting to receive test results?

Yes

5) In the past 14 days, have you or anyone residing in your home traveled outside of the United States?

Yes

6) Within the past 14 days, have you or anyone residing in your home tested positive for COVID-19, or are you presumptively positive for COVID-19 based on your health care provider’s assessment or your symptoms?

Yes

Certification

I hereby certify that the responses provided above are true and accurate to the best of my knowledge.

Initials:

We are grateful for your participation, which is vital to our continued safe operation during this unprecedented time. All responses will be kept strictly confidential.