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COVID 19 Jobsite Visitor Questionnaire
COVID 19 Jobsite Visitor Questionnaire
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COVID 19 Jobsite Visitor Questionnaire Checklist

Use this Digital Checklist
Download as PDF
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Free COVID 19 Jobsite Visitor Questionnaire Checklist

Use this Digital Checklist

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Inspection

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
COVID 19 Jobsite Visitor Questionnaire
Go Digital

COVID 19 Jobsite Visitor Questionnaire

Use this Digital Checklist
Download as PDF
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.

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