Title Page
-
Conducted on
-
Prepared by
Questionnaire
-
This questionnaire has been developed to confirm you are ready to work, and have been informed about what needs to do to help prevent the spread of COVID-19 in the workplace. We must work together to protect everyone at the workplace
Questionnaire
-
Do you feel well and fit enough to return to work?
-
Are you keeping up to date with the latest COVID-19 advice from Government?
-
Are you aware of the signs and symptoms of COVID-19?
-
Do you know how the virus is spread?
-
Have you completed Covid pre-return to work form and given to your employer?
-
Have you told your employer if you fall in to any of the at-risk categories?
-
Have you been given an induction before returning to work and made aware of the control measures put in place in the workplace to minimise the risk of you and others being exposed to COVID-19?
-
Have you co-operated to make sure these control measures are maintained?
-
Do you know who your COVID-19 Co-ordinator and Managers are and how to contact them?
-
Do you know how to contact your COVID-19 Co-ordinator if you have any concerns about exposure to COVID-19, control measures not been maintained or have any suggestions that could help prevent the spread of the virus?
-
Do you know what to do in relation to physical distancing, good hand hygiene and respiratory etiquett
-
Do you know how to wash your hands properly?
-
Do you know when to wash your hands?
-
Do you know where your nearest hand washing / hand sanitising stations are in the workplace
-
Do you know to avoid touching your face
-
Do you know to keep physical distancing from others at all times at work, including in any canteen or wash/changing room/store room.
-
Do you know to avoid any physical contact with colleagues, customers or visitors?
-
Do you know what to do if you start to develop symptoms of COVID-19 while at work, including where the isolation area is?
-
Do you understand the purpose of maintaining a COVID-19 contact log
-
Do you understand any proposed new staff rosters, changing of start / finish times,<br>rostering of breaks etc?
-
Have you been made aware of any changes to risk assessments relevant to your work activities and any changes in the safety statement in response to controls to minimise the risk of you and others being exposed to COVID-19?
-
Have you been made aware of any changes to the emergency plans or first aid procedures for your workplace in response to controls to minimise the risk of you and others being exposed to COVID-19?
-
Do you know to avoid sharing items such as cups, bottles, cutlery, pens etc?
-
Have you been made aware that any personal items brought into work must be cleaned and to avoid leaving them down on communal surfaces or to clean the surface after the personal item is removed?
-
Have you been provided with cleaning materials, including gloves and disinfectant to clean your own workspace twice daily?
-
Do you know to clean your hands before and after using public transport when commuting and when you enter and exit the workplace?
-
Can you avoid work-related travel as far as possible and are you able to conduct meetings with colleagues / clients / customers in other forms e.g. phone, online rather than in person?
-
If using your own car for work, will you travel alone?
-
If you have to share a work vehicle, have you access to a face covering and products such as wipes to clean the vehicle’s frequently touched surfaces at the start and end of each shift?
-
Do you know when you have to wear PPE and how to fit, use, remove, clean, store and dispose of any required PPE?
-
Additional Information
