Clinic Sign In & Disinfectant Log

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* 1. Date

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* 2. Time Clinic Space Accessed (Arrival to Departure Time)

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* 3. Name of Person Completing Log

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* 4. Name of Person(s) Accessing Clinic (EMLG Team Member, Client, Client Caregiver, etc)

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* 5. Clinic Space Accessed

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

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* 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.

Yes