FRM061v23 Visitor Questionnaire

• Conducted on

  Date

• Full name

• Company

• Visiting

Please read the following questions carefully and answer appropriately:

• Have you been Vomiting or had Diarrhoea during the past week?

  Yes

  No

• Are you free of Infections of the Skin, Nose, Eyes, Throat and Ears?

  Yes

  No

• Do you have a Heavy Cold or Flu?

  Yes

  No

• In the past week have you been in contact with anyone with Typhoid, Paratyphoid, Cholera, Dysentery, Salmonella infection or Gastro-enteritis?

  Yes

  No

• Have you Travelled outside of the UK In The Past 14 days. (i.e. Europe, Africa, Asia, South America)

  Yes

  No

• Did you answer ‘ YES ‘ to any of the above questions?

  Yes

  No

Please read carefully and agree with the following:

• You must declare any intended use of mobile phones, photographic/recording equipment.

• Any medication brought onto site must be authorised for use.

• Any medication brought onto site must be authorised for use.

• Please read and abide by the factory hygiene rules.

• Nuts or products containing Peanuts, Treenuts and Sesame must not be brought onto the premises.

• Products containing allergens (Gluten, egg, milk, mustard, celery, soya, fish, shellfish, molluscs, lupins) must not be taken into the factory.

• Contractors using their own tools must ensure they are cleaned prior to use.