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COVID-19 - Health Questionnaire

Coronavirus Risk Assessment

This risk assessment is a mandatory requirement for access into A1 Personnel during a time of heightened pandemic concern.
Please complete this form and return to A1 Personnel BEFORE your visit. If your visit has not been prearranged and this form has not been complete and returned before your visit you may be denied entry to A1 Personnel.

The information provided will be treated with the utmost confidence and is required to ensure the safety of the A1 Personnel staff and yourself.
A1 Personnel may be required to contact you should any signs of coronavirus be identified after your visit.
The provided information will be held securely and will be securely destroyed 1 month after your visit to site.

Please inform Wayne Cunningham, Director, A1 Personnel on 07714 481177 / with your name and location you visited should you fall unwell within the next 14 days.

Assessment Instructions and Guidance

If you have responded Yes to Questions 1, 2 or 3 please see the NHS website and please consider the nature of the illness, the likelihood that the illness maybe related to the Coronavirus, the risk of travelling to yourself and others, please discuss concerns with your prospective A1 Personnel Contact.

If you have responded Yes to Question 4, please discuss with your A1 Personnel Contact.

Health Questionnaire

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