Visitors and Contractors Health Questionnaire
Skin Disease (eczema, dermatitis, psoriasis)
Stomach or bowel disorders
Jaundice or Hepatitis
Food poisoning symptoms
Hearing loss/discharging ears
Fits, blackouts, migraines
Productive cough and/or sneezing
A Food Allergy of any type
If YES, please state what allergy you are sensitive to
Have you been outside of the UK in the last 3 months?
If YES, where?
If YES, did you have to seek medical advice for any food poisoning symptoms?
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
If you are carrying recording or photgraphic equipment, please state what type here
carrying any personal medication
If you are carrying personal medication please state what type here
carrying any allergens on my person or belongings
If you are carrying an allergen(s)t, please state which allergen you are carrying; a complete list can be found via the below link
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.