Title Page

  • Conducted on

  • Prepared by

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<br>Diarrhoea<br>

  • 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

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.