Grissan Contractor Pre-Entry Questionnaires

• Contractor Name

• Contractor Company

• Date/Time of Assessment

  Date
• Location:
  Address

• Have you travelled out with UK in last 3 months?

  Yes

  No

• Have you travelled to any of the following CAT 1 countries?

  Select Yes No

  • Yes
  • No

CAT 1 Countries

• Mainland China including Hong Kong and Macau,Iran,Italy,South Korea,Japan,France,Germany,Switzerland, San Marino,Spain

• Have you Travelled to any of the following CAT 2 Countries?

  Yes

  No

CAT 2 Countries

• Thailand,Singapore,Taiwan,Malaysia,Laos,Cambodia,Vietnam,Myanmar,Iceland,Norway,Bahrain,Eygyt,Mongolia,Azerbaijan,Turkmenistan

• Since your return have you experienced a persistent cough?

  Yes

  No

• Since your return have you had an elevated temperature greater than 38.2 degrees C?

  Yes

  No

• Since your return have you experienced difficulties breathing? I.e shortness of breath?

  No

  Yes

• Have you been in contact with anyone who has travelled to or passed through any of the CAT 1 or CAT 2 countries in last 3 months?

  No

  Yes

• Do you currently feel fit and well?

  No

  Yes

• Contractor Access Approved

  No

  Yes

• Approved By

• Position