title | COVID-19 Self Assessment Form |
---|
Site.-.MACH COVID-19 Self Assessment Form
Click here to download a copy of the form
- Only required for new inductees to Mach Energy
- Must complete all sections of form
- Question 1, if answered Yes to essential the time frame must be added
Questions
Can Accept
Send to site
1. Is your intended site visit essential?
Not essential
- please correspond with your main point of contact via phone or email
Essential
- can it be postponed to a later date? - what timeframe would the visit need to be carried out in?
YES
Timeframe = XXXX
NO
2. Do you currently have respiratory or flu like symptoms such as coughing, sore throat, fatigue or shortness of breath?
NO
YES
3. Do you currently have a fever?
NO
YES
4. Have you returned from overseas travel in the past 14 days?
NO
YES
5. In the last 14 days have you been in contact with a confirmed or potential case of Coronavirus (COVID-19)?
NO
YES
- Issue date – Date of submission
- Expiry date – Induction expiry date
Expand | ||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ||||||||||||||
|
Expand | ||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ||||||||||||||
|
Expand | ||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ||||||||||||||
|
Expand | |||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| |||||||||||||||||||
|