COVID-19 (Novel Coronavirus) questionnaire

The safety of our Employees, Families, Student’s, and visitors remain EHUK’s overriding priority.

As the coronavirus disease 2019 (COVID-19) outbreak continues to evolve and spreads globally, EHUK are monitoring the situation closely and will periodically update company guidance based on current recommendations from the Centers for Disease Control and Prevention and the World Health Organization.

Only business critical visitors are permitted at this time.

To prevent the spread of COVID-19 and reduce the potential risk of exposure to our Families, student’s, and visitors, we are conducting a simple screening questionnaire.

Your participation is important to help us take precautionary measures to protect you and everyone in this building.

Thank you for your time.

Name (required)	Date (required)
Visitor’s Company/Organization (if applicable)	Guardianship /Agent
Email	Telephone
Country travelled from to enter UK	EHUK Staff - Seen By

Self Declaration

Have you returned from any of the countries listed on official UK Coronavirus (COVID-19): travel corridors at gov.uk which is not exempt from quarantine within the last 14 days?	YesNo
Have you had close contact with or cared for someone diagnosed with COVID-19 within the last 14 days?	YesNo
Have you been in close contact with anyone who has travelled within the last 14 days to one of the countries listed on official UK Coronavirus (COVID-19): travel corridors at gov.uk	YesNo
Have you experienced any cold or flu-like symptoms in the last 14 days (to include fever, cough, sore throat, respiratory illness, difficulty breathing)?	YesNo
Have you been tested for COVID-19 as you are a Key Worker or through symptoms and please note the results?	YesNo PositiveNegative
If Tested positive for COVID-19 are you fully recovered and non-contagious	YesNo

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