AOTV COVID-19 Screening Questionnaire

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We're looking forward to seeing you! So that we can keep everyone as safe as possible, we're asking everyone who is having a face-to-face contact with our staff and contractors to complete this screening questionnaire.

Please only complete this questionnaire 24-72 hours before the session start time.

The data collected will only be used to determine if face-to-face contact can be done safely and for 'Track and Trace' purposes. If you have any questions, please e-mail info@aotv.co.uk

Full name *

Contact phone number *

Shoot you are due to take part in? *

Do you currently have a diagnosis of COVID-19 or are waiting the result of a viral test (not an antibody test)? *

Yes

Are you experiencing any of the symptoms below? (Please tick) *

Temperature of 38C or above

A new, continuous cough - coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours. If you usually have a cough, it may be worse than usual

A loss or change to your sense of smell or taste – this means you've noticed you cannot smell or taste anything, or things smell or taste different to normal

None of the above

Required

Can you confirm that no members of your household have experienced symptoms of coronavirus in the last 14 days, or are self-isolating, or that, to the best of your knowledge, no member of the household has been exposed to the virus in the last 14 days? *

Yes

Can you confirm that you have not visited a country that requires you to self-isolate on your arrival to the UK within the last 14 days? *

Yes

Can you confirm that you will keep a minimum of two metres away from all AOTV staff and contractors during the session? *

Yes

Can you confirm that you will use the hand sanitiser provided and wear a face mask at all times when practical to do so? *

Yes

Can you confirm that you will contact AOTV if the answer to any of these questions change prior to the scheduled session? *

Yes

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