Generate your own sample COVID-19 questionnaire by referring to this digital waiver form.
COVID-19 Questionnaire
We remain committed to the health and safety of our teammates, supplier partners, customers, families and visitors as the Coronavirus disease 2019 (COVID-19) outbreak continues to evolve. In order to prevent the spread of COVID-19 and to reduce the potential risk of exposure to our workforce and visitors, we have implemented precautionary measures, one of which includes temperature screening at the gate.
Upon your arrival at the gate, when scanned, if your body temperature exceeds the MOH guidelines of 37.3°C, or you are experiencing coughing or shortness of breath you will not be allowed access on site.
As an additional precaution, we have now implemented a screening form which MUST be completed by all Contractors or Visitors entering the compound. The record will be maintained as a private medical record.
This screening form mustbe reviewed by security officers before entry is allowed into our facility.
COVID-19 Screening Form
Please enter your full name.
Please enter your phone number.
Please enter your answer here.
Please enter your answer here.
Please enter your phone number.
Please enter a number.
Please enter your answer here.
Self-Declaration
Please select at least one choice above.
Please select at least one choice above.
Please select at least one choice above.
Please select at least one choice above.
Please select at least one choice above.
NB: If the answer is “yes” to any of the questions, you will not be allowed entry to our premises.
Click to sign
Please sign here.
Please enter valid date.
Click to sign
Please sign here.
Please enter valid date.
Please enter your answer here.
Note: If you plan to be on-site for consecutive days, please immediately advise us if any of your responses change. The information collected on this form will be used to determine your access right to our facility.
