Title Page

  • Today's date

  • Name

DCC Worker Declaration

  • I declare that I HAVE NOT: * arrived into NZ within the past 14 days; been in contact with someone with COVID-19 symptoms; had any COVID-19 symptoms

  • DCC Worker Name/Signature:

  • Visiting/Entering Site
  • Location
  • Site Arrival Time

  • Name & Location of facility/ site /Company you are visiting /entering for work

  • This could be the name of the facility you are entering for work e.g. Moana Pool or it could be the address of a person you are visiting at their property or it could be a contractor site you are visiting.

  • Name(s) of people you had any contact with at the above and their contact numbers

  • Names of people you travelled with & their contact numbers

  • Sign out (DCC worker leaving site)

End of Day

  • Export this register and send to your Team Leader/Manager

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.