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Declaration of Isolation or COVID-19 Diagnosis

Declaration of isolation or diagnosis of COVID-19 is required in order to limit the spread and protect the health and safety of all employees of the LOU-TEC Group Inc. The information collected will be kept secure and no personal information will be will be disclosed except as required by law or with the consent of the employee.

The People and Culture and Payroll departments will receive a notice informing them of the start and end period of the isolation related to your declaration and your ability to maintain your telework activities.

***IMPORTANT*** If you are unable to report to work due to COVID, you must complete this form each day before 9 a.m.


Please select the day that applies to your situation (eg select day 2 if you are starting your second day of your 5 or 10 day isolation period depending on your vaccination status). See CNESST isolation recommendations.


Situation applying to my condition 

I hereby declare:

Symptom status

Isolation period


Uniquement si votre poste vous le permet, aujourd'hui, êtes-vous en mesure de maintenir votre prestation de travail en télétravail pendant votre période d'isolement ?
Si oui, est-ce qu’une entente de télétravail a été discutée avec votre gestionnaire en fonction de votre poste ?

Person to contact in case of hospitalization


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Thank you for what you sent !

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