Visitors and Contractors Health Questionnaire
A dry persistent cough, and or fever (high temperature > 37.8 ◦C), loss of taste or smell
Skin Disease (eczema, dermatitis, psoriasis)
Stomach or bowel disorders
Jaundice or Hepatitis
Food poisoning symptoms
Hearing loss/discharging ears
Fits, blackouts, migraines
Have you been abroad in the last 28 days?
If YES, please state where?
If YES, did you have to seek medical advice for any symptoms you have been displaying?
Have you been in contact with anyone who is/has been suffering with any of the above within the last 48 hours?
Have you ever had or are you known to be a carrier of typhoid or paratyphoid?
Have you visited another food premises today?
If YES, what products were they handling?
I declare that
carrying recording or photographic equipment
carrying any personal medication
carrying any allergens on my person or belongings
read and understood the notice QMIC-C Version 2.4 regarding instructions to Visitors (including contractors).
By clicking this box, I declare that to the best of my knowledge, the information given in this document is true and accurate. I do not suffer from any illness or disability, which is likely to cause a food safety or a health and safety hazard.
Please note: All of the EU's14 Registered Allergens are currently stored in our warehouses and chilled chambers; please advise your host if you are allergic to any of these substances.