Visitors Covid-19 Questionnaire

This questionnaire must be completed by any visitor entering the building

Date *

Time In *

Learner Name *

Class Name *

Mobile Number *

Email *



Code of Conduct for Visitors / Contractors

A. That you will adhere to Company Policies, follow direction from our staff, adhere to signage, on-site standard processes, procedures regarding infection and contamination control.
B. Visitors must adhere to the one way entry/exit in the centre.
C. Learners must wear face masks while in the centre and adhere to the 2-metre distance rule.
D. All learners must answer the following questions

Dou you have the following symptoms? (tick the check box if Yes)


1. Diarrhoea or vomiting


2. Infections of the ears, eyes, nose, throat, skin or chest


3. Flu like symptoms / symptoms of COVID-19


4. Experiencing any fever like / Temperature symptoms


5. Experiencing difficulty in breathing, shortness of breath


6. Have you ever suffered from or been in contact with someone suffering from a notifiable disease (e.g. COVID-19) & / or have symptoms listed above


7. Did you consult a doctor or medical practitioner in the last 14 days for any of the above symptoms


8. Have you returned from an area where there are travel restrictions in the past 14 days


9. Have you been in contact with someone who has visited an infected region in the past 14 days

Thank you for completing the questionnaire. The information you have given will be treated in the strictest confidence. If for any reason, you are unable or unwilling to answer the above questions, you may not enter.

I confirm that I understood the 'Code of Conduct for Visitors' and that the above information is correct.



Signature: *



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