CORONAVIRUS DAILY HEALTH CHECK FORM FOR LINGWOOD CARE FARM
In response to the global escalation of the coronavirus, Lingwood Care Farm is taking precautionary steps to protect the wellbeing of everyone that attends our farm. These measures reflect current Government guidance.

Everybody attending our site (e.g attendees, volunteers, contractors etc) are required to complete this questionnaire on a daily basis before coming onsite.

Please complete this form before coming to the farm each day.
You will not be allowed on farm unless we have received a satisfactory completed form every day.

Lingwood Care Farm reserves the right to refuse entry to the farm.

Visits/attendance are strictly by prearranged appointment only.
Mandatory Precautions
Everyone is expected to follow increased levels of personal hygiene:
• Wash your hands (for at least 20 seconds or more) on arrival and departure
• Where possible carry and use 60% alcohol hand sanitiser.
• Avoid shaking hands.
• Comply with social distancing measures (2-meters / 6 ft / 3-steps)
• Wear a face mask when inside or in enclosed spaces (Unless medically unable)

Temperature Checks may be undertaken.

Name and Company *
Are you displaying any of the main symptoms of coronavirus? If any symptoms are ticked you MUST not come to the farm, call 119 for a test and self isolate for 14 days. *
Required
Do you live with or been in contact with someone that has the symptoms of coronavirus? *
Have you returned from abroad within the last 14 days or been in contact with someone who has? *
Are you one of the vulnerable groups? Over 70, Under 70 and have an underlying health condition, Pregnant, Clinically extremely vulnerable (contacted by NHS via letter or text) *
If your answers to the above questions change from No to Yes over the next 24 hours *
Personal data
Any personal data submitted pursuant to this questionnaire will be used for the purposes of us confirming your identity, assessing your suitability for accessing the site, ensuring appropriate controls are in place where necessary with regard to your visit and ensuring your health and safety whilst on site. For further information on how we may process your personal data (including information on your rights), please read our Privacy Notice which is available https://lingwoodcarefarm.com/privacy-policy. By signing this form, you are giving us explicit consent to us processing your personal data in accordance with the above.
Signature and Date *
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