COVID-19 CHECKLIST v3

COVID-19 CHECKLIST

Elite Staffing Solutions is committed to monitoring Covid-19 development amongst its employees. Please answer the following questions. (This form is subjected to change depending on the circumstances of Covid-19).
Site (if applicable)
Your worksite*
Name*

First NameLast Name
Email*
example@example.com
Consultant/Account Manager:*
Choose one
Have you developed any flu-like symptoms within the past 7 days?*

YesNo
If yes, DO NOT ATTEND YOUR WORK SITE & please contact your Account Manager or call 1300808008 immediately.
_________________________________________________________

If employees experience flu-like symptoms they are not permitted on a work-site under any circumstances.

According to the Department of Health, symptoms include fever (high temperature), chills or sweats, cough, sore throat, shortness of breath, runny nose, loss of sense of smell or taste.

If you have any of these symptoms, you must obtain a medical clearance before returning to work.

If you fail to provide a medical clearance, you will not be allowed back to work. No exceptions.

_________________________________________________
COVID-19 CHECKLIST

Elite Staffing Solutions is committed to monitoring Covid-19 development amongst its employees. Please answer the following questions. (This form is subjected to change depending on the circumstances of Covid-19).
Have you visited anyone who has had any flu-like symptoms within the past 7 days?*

YesNo
If yes, please contact your Account Manager or call 1300808008 immediately.
Have you visited a Tier1 or Tier 2 exposure site within the past 7day?*

YesNo
If yes, DO NOT ATTEND YOUR WORK SITE & please contact your Account Manager or call 1300808008 immediately.
Do you have a second Job?*

YesNo
If yes, please contact your account manager or call 1300808008 immediately.
Have you received your FIRST Covid 19 vaccination? (select one)*

YesNo
Have you received your SECOND Covid 19 vaccination? (select one)*

YesNo
Are you booked in to have a vaccination in the next 7 days? (select one)*

YesNo
Please practice and maintain personal hygiene standards for the betterment of you, your family/friends as well as your co-workers.

If you need to cough or sneeze, please do so with you mouth covered. Ensure that you wipe down hard surfaces with soap regularly.

When washing your hands, ensure you wash with warm water and soap for at least 20 seconds (remember to clean underneath fingernails and between fingers). Please also come to work with clean clothes.

Please inform your Elite Staffing consultant if you develop a communicable illness. Sick workers are not permitted to be on site as they can contaminate products which could put a risk to workers and the general public.

Covid-19 (along with any other communicable illnesses) can be dangerous to the public, especially those who are immune deficient (individuals who have weak immune systems: children, elderly, cancer patients, etc).

Failure to comply with the above procedures may affect your future employment with Elite Staffing Solutions.

Thankyou.
I ___________________________understand that if I go to work with an illness, I may cause detrimental consequences for other workers and the general public. I agree that if if I am assigned a shift of work and I develop an illness, I will inform Elite Staffing Solutions that I cannot attend work before my shift commences. I understand, in order to go back to work after an illness, I will be required to provide a medical clearance from a doctor. Based on that clearance, my Elite consultant will determine if it is acceptable for me to return to work. If any item on this checklist changes in the future, I will inform Elite Staffing Solutions as soon as possible. I declare everything I have checked is true.*
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