Covid 19 Safety Survey
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COVID-19 SAFETY RULES
DO NOT ENTER, if you have been exposed to anyone that has tested positive for COVID-19 within the last 14 days.
DO NOT ENTER, if you experienced any COVID-19 symptoms within the past 14 days and CALL & REPORT your symptoms to your manager/supervisor.
DO NOT ENTER, if you have a high temperature. CALL & REPORT your symptoms to your manager/supervisor.
Masks must be worn at all times while indoors.
If you have been vaccinated for Covid-19, PROVIDE a copy of your vaccination card to Human Resources.
Bi-weekly testing is mandatory for all unvaccinated Staff and Participants.
Please answer the following questions.
Yes
No
Short Notes
Have you been exposed to anyone that has tested positive for COVID-19 within the last 14 days?
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Have you experienced any COVID-19 symptoms within the past 14 days?
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4
Do you have a high temperature?
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Are you wearing a Mask?
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Have you been vaccinated for Covid-19?
Yes
No
Please provide a copy of your vaccination card.
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Have you been tested for COVID-19 within the last 2 weeks?
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No
Please enter date of your last Covid-19 Test.
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I, undersigned, agree with the following statements:
I verify that the information I am submitting here is complete and accurate.
I understand and agree with the COVID-19 Safety Rules.
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