COVID-19 Health Questionnaire CoVID-19 Health Screening Questionnaire In order to prevent the spread of COVID-19 and to help reduce the potential risk of exposure we are requesting all delegates to complete and submit this questionnaire prior to commencing training. Please respond to each of the following questions truthfully and to the best of your ability to help protect everyone. Please note it is the person coming to HelCat that completes this form. Name* First Last Email Enter Email Confirm Email You will recieve confirmation of this form.Course*Please enter the course you are attending or enter CSCS if attending for a CSCS Card test.Phone*EmployerAre you feeling well today?*YesNo2. In the past 14 days have you experienced any cold or flu-like symptoms (including fever, cough, sore throat, respiratory illness, difficulty breathing)?*YesNo3. In the past 14 days have you experienced a loss or change in your sense of taste of smell?*YesNo4. In the past 14 days have you been in close proximity to anyone who was experiencing any of the above symptoms (Q2 & Q3) or experienced any of the above symptoms since your contact?*YesNo5. In the past 14 days have you returned from or been in close contact with anyone who has returned from a country that requires you to quarantine?*YesNoIn the last 14 days have you been in close proximity to anyone who has tested positive for COVID-19?*YesNoHave you been out with the area in the last 14 days?YesNoTier LevelTier Level 1Tier Level 2Tier Level 3Tier Level 4Tier Level 5If you have been out with the area in the last 14 days, please let us know what tier level you were in.7. Have you been tested for COVID-19 and are waiting to receive test results?*YesNoConsent* I hereby certify that the responses provided above are true and accurate to the best of my knowledge.CommentsThis field is for validation purposes and should be left unchanged.
