Visitor Health Declaration | EDWPS

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0115 939 9797

Covid-19 Health Declaration

How are you feeling today?

First Name

Last Name

Company

Email

My body temperature is lower than 98.6°F/ 37.5°C

I am not experiencing the symptoms: fever, cough, sore throat

I haven’t been in close contact with a Covid-19 patient in the last 14 days

Initials

Date

I declare that the info I’ve provided is accurate & complete

Prior to arrival, in-line with government guidelines, we ask visitors to download the NHS Track and Trace app on their smart devices.
We recommend you also check in with this app on arrival in our reception.

We look forward to seeing you.

0115 939 9797

©2019 by Eight Days a Week Print Solutions Ltd.

Eight Days a Week Print Solutions, 1 Glaisdale Point, Glaisdale Parkway, Nottingham, NG8 4GP

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