Burbank COVID-19 Checklist

• Conducted on

  Date

• Prepared by

• Location
  Address

• Company Represented

• At Burbank, we are doing everything possible to keep our customers, staff, contractors and the wider community safe.
  In line with the Government' direction we are taking the required measures including this checklist for you to complete to ensure we operate in a safe environment for all.

• Have you or someone you've been in close contact with, a person who has visited a Gov declared red zone (COVID hot area) in the last 14 days

  yes

  no

• Refuse entry to site and reschedule appointment/trade until required isolation period has been completed and evidence of a negative COVID test can be provided.

• Are all people on site wearing a face mask inline with Government requirments

  Yes

  No

  N/A

• Have you been recently tested for COVID 19.

  Yes

  No

• Please provide evidence of a negative result (screen shot - refuse entry on site if this cannot be provided)

  Media

• Do you have any signs of a cold or flu

  Yes

  No

• refuse entry from site (cannot return to site unless evidence of a negative COVID result can be provided)

  Yes

  No

• Are you in close contact with some who has tested positive and currently required to isolate

  Yes

  No

• Do not allow access to site - report to R&C

  Yes

  No

• Have you scanned the Government COVID QR code and completed the required information

  Yes

  No

• Ask the person to scan the site Gov QR code

  Yes

  No

• Refuse entry from site or if on site MUST be removed from site (Zero Tolerance, R&C approval required to return to site)

Sign Off

• Comments

• Photo of Epass or (ID if not a Burbank Contractor)

  Media

• Photo of Epass or (ID if not a Burbank Contractor)

  Media

• Photo of Epass or (ID if not a Burbank Contractor)

  Media