• Employers should consider screening visitors. If a visitor answers “Yes” to any of the following sample questions, he/she should not be permitted to access the jobsite.

QUESTIONNAIRE

  • 1. Have you been confirmed positive for COVID-19?

  • 2. In the last 72 hours, have you had: a new fever of 100.4°F, a new cough, shortness of breath, sore throat, new muscle aches or a loss of taste or smell?

  • 3. Have you or someone in your household or workplace been in close contact with a person who has signs of or has COVID-19?

  • 4. Have you been in close contact with any persons who have traveled and are also exhibiting acute respiratory illness symptoms?

SIGN OFF

  • Health and Safety Officer Signature

  • Visitor's Signature

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