Supplier/Visitor/Subcontractor Assessment Form
Due to the evolving situation with the novel Coronavirus (COVID-19), the Danco Group is taking precautionary measures of all individuals who enter our offices and jobsites by completing a Safety Assessment.The Danco Group reserves the right to evaluate the potential for health and safety risks at our discretion and deny access on any premises.
Your name and email *
Date *
Do you certify that you have provided the below information accurately to the best of your knowledge? Do you understand that if your travel status changes and/or you have contact with a confirmed or suspected case of COVID-19 and/or experience a fever, a cough, or have difficulty breathing, you must notify the project supervisor or Danco Jobsite representative IMMEDIATELY? [ Please type your name below to sign] *
In the last 14 days, have you been in close contact with a CONFIRMED or SUSPECTED COVID-19 case? (If YES, you are not allowed to access the worksite. We will adjust appropriately.) *
In the last 14 days, have you experienced any of the following: fever, sore throat, cough, or difficulty breathing? (If YES, you are not allowed to access the worksite and please call your health care provider or DHHS.) *
If the answer is YES to any question above the individual is not cleared to enter any entity at the DANCO GROUP and is required to speak with Julianne Eagle, 707-410-6227
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy