CTS Staff COVID-19 Screening Questionnaire In response to the recent Coronavirus (COVID -19) outbreak and the raised pandemic alert status by the World Health Organisation (WHO) and the UK Government, Chase Training Solutions is taking precautions to lessen the spread of the virus and protect all those that we engage with. All employees, independent contractors and freelance staff must have a screening form completed and submitted prior to taking part in the activity for which they have been engaged. CTS STAFF COVID-19 SCREENING FORMPlease review the following self screening criteria:First Name *Last Name *Email *Date of Birth *Date of Activity (from/to) *Have you or anyone in the household/support bubble tested positive for COVID-19 within the past 10 days? *YesNoHave you or anyone in the household/support bubble been tested for COVID-19 and are waiting for results? *YesNoHave you or anyone in the household/support bubble experienced a continuous cough within the past 7 days? *YesNoHave you or anyone in the household/support bubble recently lost or experienced a change to sense of smell or taste within the past 7 days? *YesNoDo you or anyone in the household/support bubble have a high temperature (38C or 100.4F) and above within the past 7 days? *YesNoEven if you don’t currently have any of the above symptoms, have you or anyone in the household/support bubble experienced any of these symptoms in the last 10 days? *YesNoHave you or anyone in the family household/support bubble been in knowing contact with someone who has tested positive for COVID-19 in the last 10 days? *YesNoHave you or anyone in the household/support bubble travelled outside the United Kingdom in the past 10 days? *YesNoHave you had a request from NHS Test and Trace to self-isolate in the past 10 days? *YesNoHas anyone in the household/support bubble/you have had contact with had a request to self-isolate within the past 10 days? (copy) *YesNo If answered YES to any of the above questions, notify Ben Cleverley or Dave Mayo immediately.By submitting this document you agree to a non-contact temperature check upon arrival at the activity venue and, if deemed necessary, at any point during this activity *YesSignature * Date/Time *CommentSubmit
