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Visiting
Questionnaire
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As the Coronavirus Disease (COVID-19) outbreak continues to evolve, we are conducting a simple daily screening questionnaire in order to reduce any potential risk of exposure to our employees, customers and visitors.
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NOTE: When on site, please adhere to our on-site standard processes/procedures regarding infection control, i.e. hand washing/hand sanitising and general coughing/sneezing etiquette.
Now or in the last 14 days, please confirm you or a cohabitant or a close family member have not;
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Visited any countries outside of Ireland excluding Northern Ireland.
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Had any flu like symptoms/symptoms of COVID-19 (fever, cough, difficulty breathing)
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Been in contact with or near (less than 2 meters for more than 15 minutes in 1 cumulative<br>day) anyone who is now diagnosed to have COVID-19 (Coronavirus)
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Been advised by a Doctor to self-isolate or cocoon
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Been in a hospital, care facility, work environment, which has experienced a known outbreak of COID-19 in the past 14 days.
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Did you answer ‘ YES ‘ to any of the above questions?
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PLEASE DO NOT PROCEED INTO THE WORKPLACE AND SELF ISOLATE IMMEDIATELY IN THE PRE DETERMINED SELF ISOLATION ROOM.
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Access to workplace
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Access determined by (Name)
