Rynpark Entry Log

Name Surname

Contact Number

Vehicle Reg

Reason for entry

Rynpark Unit Number

Here to see?

From?

Do you have any of the following COVID-19 symptoms?

Fever

Dry cough

Tiredness (Fatigue)

Difficulty breathing or shortness of breath

Sputum production

Chest pain or pressure

Body ache and pains

Myalgia or arthralgia (Muscle or joint pain)

Sore throat

Headache

Chills

Gastrointestinal symptoms such as nausea, vomiting or
Diarrhoea

Anosmia (loss of sense of smell) and dysgeusia (alteration of the sense of taste)

Do you have any chronic respiratory illness, example Asthma, Emphysema, COPD?

Have you been in contact with somebody that could be infected?

Have you been to a Hospital in the last 2 weeks, if Yes please provide information

Have you been to a Funeral in the last 2 weeks, if Yes please provide information

Temp Reading 1
Temp Reading 2

Reported abnormalities / high temperature to

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.