Roastery Visitor Health Questionaire
Welcome To The Volcano Coffee Works & Assembly Coffee Roastery.
This is a SALSA acredited food production facility, so we just need to ask you a few questions before we get started
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Your Name
First Name
Last Name
Your Company Name
Are you here for:
Training
I'm a supplier
I'm a client
Other
Which training?
Beginner Coffee Maker
Latte Art Training
Intermediate Coffee Maker
Technical Training
Are you or have you:
Rows
Yes
No
Suffering from a fever (37.5 deg or above), new or persistent cough, or having reduced sense of taste or smell
1
2
Been in close contact with someone who has had a confirmed case of Covid-19 in the last 10 days
3
4
Been told to isolate by the NHS track and trace or other relevant medical authority
5
6
At present or in the last 7 days were/are you suffering from
Rows
Yes
No
Diarrhoea
7
8
Stomach pain, Nausea or fever
9
10
At present are you suffering from:
Rows
Yes
No
Skin infestions of the hands, arm or face, eg. boils, styles, septic fingers, discharge from ears/gums/mouth
11
12
Jaundice
13
14
Do you suffer from:
Rows
Yes
No
A recurring bowel dissorder
15
16
Recurring infections of the skin ear or throat
17
18
Rows
Yes
No
Have you ever had typhoid or paratyphoid fever or are you know to be a carrier of Salmonella Typhi or Paratyphi
19
20
In the last 21 days have you been in contact with anyone at home or abroad, who may have been suffering from
typhoid or paratyphoid
21
22
Any countries visited in the last 6 weeks
The answers to the above questions are accurate to the best of my knowledge
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