Food Delivery Health & Safety Questionnaire Form
Complete this Food Delivery Health & Safety Questionnaire Form to confirm your operational readiness and delivery safety details before starting your shift.
Contact Name
*
First Name
Last Name
Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Delivery Shift Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Current Health & Safety Readiness
*
Ready to begin shift (no symptoms, fit for duty)
Not ready (will not proceed with delivery)
In the last 24 hours, have you experienced any new symptoms or been exposed to anyone with a contagious illness?
*
No
Yes (do not proceed with delivery)
Delivery Vehicle or Method
*
Please Select
Car
Motorcycle/Scooter
Bicycle
On Foot
Other
Have you confirmed proper food handling hygiene for this shift?
*
Yes, hygiene protocols confirmed
No (do not proceed with delivery)
Is temperature-control equipment available and functioning (if required)?
*
Yes
Not required for this delivery
No (do not proceed with delivery)
Sanitizer and PPE Availability
*
Sanitizer and PPE available for this shift
Not available (do not proceed with delivery)
Incident Reporting (briefly describe any issues or incidents during delivery, or enter 'None')
*
Additional Notes or Delivery Restrictions
Submit Questionnaire
Should be Empty: