HVWS Visitor Self Screening Checklist Form
HVWS is restricting all nonessential visitors/vendors/contractors from entering buildings on campus at this time. In addition, the following protocols must be met:

All visitors/vendors/contractors must answer health screening questions.

All visitors/vendors/contractors are required to wear face coverings.

Hand sanitizer must be used at all points of entry to buildings for visitors and vendors to use upon entering a building or any room within a building.

Site deliveries should include only minimal contact and cleaning protocols should be followed. Delivery personnel should practice physical distancing measures and wear a mask. If this is not possible, they stay in their vehicles.

Visitor COVID-19 Health Screening

In an effort to continue to provide a safe workplace, prevent the spread of COVID-19, and comply with the Connecticut requirements, all visitors must confirm they are not experiencing COVID-19 defined symptoms.

Please complete the following questions. If you answer “yes” to any of the questions, you are not permitted to be on campus.

Email Address *
First and Last Name *
Organization or Company you represent, or, staff or faculty member you are assisting. *
Date of visit *
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy