Covid-19 Visit Assessment
To ensure that we are doing everything possible to keep our staff and costumers safe and to reduce the risk of infection we are introducing a series of measures before we undertake face to face meeting, this includes a pre-meeting assessment. Prior to the meeting we require you to carefully full out and return this form below. If you have any questions concerning this matter please do contact us.
Potential Project Code:
Don't worry about this question it is for us to fill out!
Name(s) of those attending:
*
Have you or anyone attending the meeting received their covid-19 vaccination?
*
Yes
No
If you answered yes above how many of you have had the vaccination?
Meeting Details: - Please insert the date followed by the time
*
1. Are you, or any person, in your household or bubble currently self-isolating due to covid-19?
*
Please Select
Yes
No
2. Are you, or any person, in your household or bubble currently showing any symptoms covid-19?
*
Please Select
Yes
No
3. Are you, or any person, in your household or bubble recovered from covid-19?
*
Please Select
Yes
No
4. Are you, or any person, in your household or bubble been advised by the NHS that they are classified as a venerable person?
*
Please Select
Yes
No
5. Are you, or any person, in your household or bubble classified as a key worker?
*
Please Select
Yes
No
6. During the meeting do you agree to adhere to the social distancing guidance as advised by Public Health England?
*
Please Select
Yes
No
7. Do you agree to notify us should their be any change to your response to questions 1,2 or 3 above, subsequent to the meeting ?
*
Please Select
Yes
No
Submit
Thank You
Thank you for submitting this form. We look forward to meeting you at a safe distance and hearing more about your project!
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