Visitor Screening - 24 Hours Before Visit
Considering the increasing spread of the coronavirus disease 2019 (COVID-19), we ask that you please answer the following visitor screening questions. While the risk of infection continues to remain low, we are committed the health of our visitors and our employees.
If the answer to any of the questions is “yes” then we ask that you not visit our facility at this time. We would be happy to reschedule your visit for a later date.
All question must be answered.
Sign in to Google
to save your progress.
General Guidance for External Visitors
The health and safety of our colleagues and visitors is our foremost priority. In our effort to prevent the spread of COVID-19, North Star Imaging requires that visitors complete and submit the following pre-facility visit screening questionnaire between 2-24 hours prior to your visit.
After North Star Imaging receives the completed questionnaire it will be reviewed by the HR or EHS Managers. If you answer “yes” to either screening question we will contact you for more information. Should it be necessary your NSI host will discuss rescheduling your visit to a later date.
The following is General COVID-19 Prevention Guidance for visitors who are approved to enter North Star Imaging facilities.
If you are in any way feeling ill (high temperature, coughing, sneezing, difficulty breathing, muscle aches) you must reschedule your visit.
When entering a North Star Imaging facility, visitors will:
1. Immediately sanitize hands using NSI provided sanitizer.
2. Always wear a face mask EVEN if you are fully vaccinated. Facemasks will be provided to you if you do not have one.
3. Have temperature checked by trained NSI personnel using a touch-free thermometer or temperature scanning camera. (No personal data is recorded.)
a. Should temperature be at or above 100.4, visitor WILL NOT be allowed to enter the NSI facility and visit will be rescheduled.
4. Maintain social distancing limits of at least six feet with NSI employees and other visitors while on NSI premises.
5. Only engage with necessary NSI employee(s), and no others, to limit any possible exposure.
6. Wash hands often with soap for at least 20 seconds or use alcohol-based hand sanitizer provided by NSI.
If a visitor tests positive for COVID-19 within 14 days of their visit they are expected to notify the appropriate NSI personnel to inform them of potential exposure.
I confirm I have read the general guidance above.
When are you visiting?
Who are you visiting?
Do you have any of these symptoms that you cannot attribute to another condition including fever, cough, sore throat, shortness of breath or recent loss of taste or smell?
In the last 14 days have you been in close contact with anyone diagnosed with COVID-19 or anyone isolating because they are symptomatic?
North Star Imaging thanks all visitors for their help in preventing the spread of COVID-19.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service