{"id":2425,"date":"2020-06-10T20:39:06","date_gmt":"2020-06-10T16:39:06","guid":{"rendered":"https:\/\/securimed.ca\/covid-19-day\/"},"modified":"2020-11-30T21:13:44","modified_gmt":"2020-12-01T02:13:44","slug":"covid-19-day","status":"publish","type":"page","link":"https:\/\/securimed.ca\/en\/covid-19-day\/","title":{"rendered":"COVID-19 \u2013 Day"},"content":{"rendered":"<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_12' style='display:none'><div id='gf_12' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_12' id='gform_12'  action='\/en\/wp-json\/wp\/v2\/pages\/2425#gf_12' data-formid='12' novalidate>\n        <div id='gf_progressbar_wrapper_12' class='gf_progressbar_wrapper'>\n        \t<h3 class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>3<\/span>\n        \t<\/h3>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_33' style='width:33%;'><span>33%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_12_1' class='gform_page ' data-js='page-field-id-1' >\n                                    <div class='gform_page_fields'><ul id='gform_fields_12' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_12_938\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_12_938\" ><label class='gfield_label gform-field-label' for='input_12_938'>Num\u00e9ro d&#039;employ\u00e9 \/ Employee number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_938' id='input_12_938' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_12_514\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_12_514\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Choisir \/ Choose<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_12_514'><li class='gchoice gchoice_12_514_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_514.1' type='checkbox'  value='Fran\u00e7ais'  id='choice_12_514_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_514_1' id='label_12_514_1' class='gform-field-label gform-field-label--type-inline'>Fran\u00e7ais<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_514_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_514.2' type='checkbox'  value='English'  id='choice_12_514_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_514_2' id='label_12_514_2' class='gform-field-label gform-field-label--type-inline'>English<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_12_146' class='gform_next_button gform-theme-button button' value='\u2192'  onclick='jQuery(\"#gform_target_page_number_12\").val(\"2\");  jQuery(\"#gform_12\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_12\").val(\"2\");  jQuery(\"#gform_12\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_12_2' class='gform_page' data-js='page-field-id-146' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_12_2' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_12_515\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_12_515\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Identification<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_12_515'>\n                            \n                            <span id='input_12_515_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_515.3' id='input_12_515_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_12_515_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_12_515_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_515.6' id='input_12_515_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_12_515_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_12_516\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_12_516\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_12_516'>\n                            \n       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                               <\/span>\n                            \n                        <\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_12_231' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='\u2190'  onclick='jQuery(\"#gform_target_page_number_12\").val(\"1\");  jQuery(\"#gform_12\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_12\").val(\"1\");  jQuery(\"#gform_12\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_12_231' class='gform_next_button gform-theme-button button' value='\u2192'  onclick='jQuery(\"#gform_target_page_number_12\").val(\"3\");  jQuery(\"#gform_12\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_12\").val(\"3\");  jQuery(\"#gform_12\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_12_3' class='gform_page' data-js='page-field-id-231' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_12_3' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_12_919\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_12_919\" ><label class='gfield_label gform-field-label' >1 : Avez-vous des nouveaux sympt\u00f4mes : Fi\u00e8vre, Toux, Difficult\u00e9 respiratoire, Perte soudaine de l&#039;odorat ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_12_919'>\n\t\t\t<li class='gchoice gchoice_12_919_0'>\n\t\t\t\t<input name='input_919' type='radio' value='Oui'  id='choice_12_919_0'    \/>\n\t\t\t\t<label for='choice_12_919_0' id='label_12_919_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_12_919_1'>\n\t\t\t\t<input name='input_919' type='radio' value='Non'  id='choice_12_919_1'    \/>\n\t\t\t\t<label for='choice_12_919_1' id='label_12_919_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_12_921\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_12_921\" ><label class='gfield_label gform-field-label' for='input_12_921'>Pr\u00e9cision<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_921' id='input_12_921' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_12_920\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_12_920\" ><label class='gfield_label gform-field-label' >1: Do you have any new symptoms: Fever, Cough, Difficulty breathing, Sudden loss of smell?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_12_920'>\n\t\t\t<li class='gchoice gchoice_12_920_0'>\n\t\t\t\t<input name='input_920' type='radio' value='Yes'  id='choice_12_920_0'    \/>\n\t\t\t\t<label for='choice_12_920_0' id='label_12_920_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_12_920_1'>\n\t\t\t\t<input name='input_920' type='radio' value='No'  id='choice_12_920_1'    \/>\n\t\t\t\t<label for='choice_12_920_1' id='label_12_920_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_12_922\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_12_922\" ><label class='gfield_label gform-field-label' for='input_12_922'>Description<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_922' id='input_12_922' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_12_924\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_12_924\" ><label class='gfield_label gform-field-label' >2 : Avez-vous des changements dans votre \u00e9tat de sant\u00e9 ou avez-vous dans les derniers 14 jours voyager \u00e0 l\u2019ext\u00e9rieur du pays ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_12_924'>\n\t\t\t<li class='gchoice gchoice_12_924_0'>\n\t\t\t\t<input name='input_924' type='radio' value='Oui'  id='choice_12_924_0'    \/>\n\t\t\t\t<label for='choice_12_924_0' id='label_12_924_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_12_924_1'>\n\t\t\t\t<input name='input_924' type='radio' value='Non'  id='choice_12_924_1'    \/>\n\t\t\t\t<label for='choice_12_924_1' id='label_12_924_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_12_936\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_12_936\" ><label class='gfield_label gform-field-label' for='input_12_936'>Pr\u00e9cision<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_936' id='input_12_936' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_12_925\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_12_925\" ><label class='gfield_label gform-field-label' >2: Do you have any changes in your health or did you have travel out of the contry in the past 14 days ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_12_925'>\n\t\t\t<li class='gchoice gchoice_12_925_0'>\n\t\t\t\t<input name='input_925' type='radio' value='Yes'  id='choice_12_925_0'    \/>\n\t\t\t\t<label for='choice_12_925_0' id='label_12_925_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_12_925_1'>\n\t\t\t\t<input name='input_925' type='radio' value='No'  id='choice_12_925_1'    \/>\n\t\t\t\t<label for='choice_12_925_1' id='label_12_925_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_12_937\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_12_937\" ><label class='gfield_label gform-field-label' for='input_12_937'>Description<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_937' id='input_12_937' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_12_519\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_12_519\" ><label class='gfield_label gform-field-label' >3 : Avez-vous \u00e9t\u00e9 en contact \u00e9troit (moins de 2 m\u00e8tres et plus de 15 minutes) avec une personne qui pourrait avoir ou qui a \u00e9t\u00e9 test\u00e9e positive au COVID-19 au cours des 10 derniers jours ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_12_519'>\n\t\t\t<li class='gchoice gchoice_12_519_0'>\n\t\t\t\t<input name='input_519' type='radio' value='Oui'  id='choice_12_519_0'    \/>\n\t\t\t\t<label for='choice_12_519_0' id='label_12_519_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_12_519_1'>\n\t\t\t\t<input name='input_519' type='radio' value='Non'  id='choice_12_519_1'    \/>\n\t\t\t\t<label for='choice_12_519_1' id='label_12_519_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_12_897\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_12_897\" ><label class='gfield_label gform-field-label' for='input_12_897'>421 : Connaissez-vous la date ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_897' id='input_12_897' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_12_610\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_12_610\" ><label class='gfield_label gform-field-label' >3 : Have you been in close contact (less than 2 meters and more than 15 minutes) with a person who may have or has tested positive for COVID-19 in the last 10 days?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_12_610'>\n\t\t\t<li class='gchoice gchoice_12_610_0'>\n\t\t\t\t<input name='input_610' type='radio' value='Yes'  id='choice_12_610_0'    \/>\n\t\t\t\t<label for='choice_12_610_0' id='label_12_610_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_12_610_1'>\n\t\t\t\t<input name='input_610' type='radio' value='No'  id='choice_12_610_1'    \/>\n\t\t\t\t<label for='choice_12_610_1' id='label_12_610_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_12_899\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_12_899\" ><label class='gfield_label gform-field-label' for='input_12_899'>421 : Do you know the date ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_899' id='input_12_899' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_12_975\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_12_975\" ><label class='gfield_label gform-field-label' >4 : Indiquer votre temp\u00e9rature actuellement ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_12_975'>\n\t\t\t<li class='gchoice gchoice_12_975_0'>\n\t\t\t\t<input name='input_975' type='radio' value='Moins de 37.5'  id='choice_12_975_0'    \/>\n\t\t\t\t<label for='choice_12_975_0' id='label_12_975_0' class='gform-field-label gform-field-label--type-inline'>Moins de 37.5<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_12_975_1'>\n\t\t\t\t<input name='input_975' type='radio' value='37.6 \u00e0 37.9'  id='choice_12_975_1'    \/>\n\t\t\t\t<label for='choice_12_975_1' id='label_12_975_1' class='gform-field-label gform-field-label--type-inline'>37.6 \u00e0 37.9<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_12_975_2'>\n\t\t\t\t<input name='input_975' type='radio' value='38 et plus'  id='choice_12_975_2'    \/>\n\t\t\t\t<label for='choice_12_975_2' id='label_12_975_2' class='gform-field-label gform-field-label--type-inline'>38 et plus<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_12_975_3'>\n\t\t\t\t<input name='input_975' type='radio' value='nothermometer'  id='choice_12_975_3'    \/>\n\t\t\t\t<label for='choice_12_975_3' id='label_12_975_3' class='gform-field-label gform-field-label--type-inline'>Je n'ai pas de thermom\u00e8tre<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_12_976\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_12_976\" ><label class='gfield_label gform-field-label' >4 : Indicate your current temperature ?<span class=\"gfield_required\"><span class=\"gfield_required 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