Ensto Renley Covid-19 Staff/Visitor/Contractor Questionnaire

The information recorded in this survey is for Covid-19 tracking information only and will not be used for any other purpose.

If you respond YES to questions 4, 5, 6 or 7 you MUST exclude yourself from site. However we ask that you complete and submit this survey for our records

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* 1. Contact Tracking Information

Name

Company

Email Address

Mobile Phone Number

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* 2. What is your purpose on-site today at Ensto Renley Dunboyne?

Contractor working on site

Meeting on site

I'm an Ensto Renley employee

Delivery that requires entering site

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* 3. Who are you visiting today?

Tony Hart - Manufacturing Manager

Jonathan Redmond - Manufacturing Engineer

Daniel Joyce - Innovation Manager

John Carolan - Managing Director

Working on site

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* 4. Have you visited any of the countries outside Ireland excluding Northern Ireland in the last 3 weeks?

Yes

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* 5. Are you suffering any flu like symptoms/symptoms of coronavirus covid-19?

Yes

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* 6. Are you experiencing any fever like symptoms or a high temperature?

Yes

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* 7. Are you experiencing any difficulty in breathing, shortness of breath?

Yes

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* 8. When on site do you agree to comply with processes/procedures regarding infection control, i.e. hand washing/hand sanitising and general coughing/sneezing etiquette?

Yes