COVID-19 Health Declaration Form
This form must be filled out by (or on behalf of) the key person who will be on site when the work is carried out. If noone will be on site, then please answer for yourself.
Email address *
Full Name *
Phone Number *
Job address *
I will be onsite when the work is carried out *
Do you have a recent history of travel to areas with travel restrictions? *
Have you had close contact with someone with symptoms of COVID-19? *
Have you had indirect contact with a person with symptoms of COVID-19? *
Do you have any pre-existing respiratory conditions?
If yes, please briefly state
Have you had any of the following symptoms recently: Dry cough, shortness of breath, temperature over 38 degrees, sneezing *
If yes, have you been symptom free for 14 days?
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