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.
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.
A high temperature – this means you feel hot to touch on your chest or back (you do not need to measure your temperature)
A new, continuous cough – this means 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)
Loss of sense of taste or smell
None of the above symptoms
Do you live with or been in contact with someone that has the symptoms of coronavirus?
Yes- You MUST NOT come to the farm, You must self isolate for 14 days
Have you returned from abroad within the last 14 days or been in contact with someone who has?
Yes- You MUST NOT come to the farm
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)
Yes- Contact Sally before coming to the farm
No- Social distancing will apply
If your answers to the above questions change from No to Yes over the next 24 hours
I agree to contact the farm, seek NHS medical attention and self isolate
I do not agree
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
. 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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