visitor track & trace

Just a few quick Q's

In order to protect the health and safety of all tenants, members, staff, contractors & visitors; you are required to complete this short questionnaire before attending your meeting.

In order to comply with the Government's Test Trace Protect programme, please provide your contact details.

Thank you for your co-operation.

Private & Confidential
‍Personal InformationName of visitor / contractorWhich company are you visiting?date & time of meetingNAme of the person(s) you are meeting?please provide a contact telephone numberplease provide a contact email address
Health QuestionnaireAre you experiencing any flu like symptoms?

YES

No

Are you experiencing a high temperature / fever symptoms

YES

No

Are you experiencing any difficulty in breathing or shortness of breath?

YES

No

Are you experiencing a continuous cough?

YES

No

Are you experiencing any loss to your sense of taste or smell?

YES

No

have you had close contact with, or cared for, someone diagnosed with covid-19 during the last 14 days?

YES

No

have you travelled outside the UK during the last 14 days?

YES

No

If you have answered "NO" to all of the above questions, you will be allowed onto the premises; and must follow our protocols on infection control, including hand washing / hand sanitising, general coughing or sneezing etiquette, and social distancing. You will see the protocols on posters, signage and markings displayed throughout our premises.

If you have answered "YES" to any of the above questions, we are sorry, but you will not be allowed onto our premises.

DECLARATION
The information I have provided is true to my knowledge. I agree to adhere to the protocols provided tominimise the spread of Coronavirus, and understand that this form will be held confidentially.

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i approve

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