Visitor Food Safety Screening Form
Complete this form before entering any food-related area. Use the same title everywhere in the form.
Visitor Information
Visitor full name
*
First Name
Last Name
Company or organization name
Contact email address
*
example@example.com
Date of visit
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Visit and Screening Details
Purpose of Visit
*
Please Select
Delivery
Meeting
Maintenance
Inspection
Training
Tour
Other
Area or Department to be Visited
*
Food or Ingredient Handling During Visit
*
No
Yes, direct handling
Yes, indirect handling
Current Visible Signs That May Affect Food Safety Screening
*
No
Yes
Acknowledgement
I confirm that my screening answers are accurate and complete, and I understand access may be limited if requirements are not met
*
I Confirm
Acknowledgement signature
*
Submit
Submit
Should be Empty: