Visitor COVID-19 Checklist

This form must be completed in the time period 24-48 hours BEFORE your visit to Sigma, OPD or SigCare.

You will not be granted access to our site if this form is not completed.

Forms completed more than 48 hours before a visit will need to be repeated nearer your visit

The company request that visitors
do not attend the site if they are experiencing covid-19 symptoms or ill
health.

Visitors must inform our company
immediately if they are a confirmed covid-19 case within 72 hours after their
visit.

Please give us your full name

Your phone number

Your email address

In the event of a confirmed case of COVID-19 at Sigma, your details may be sent to the NHS TEST & TRACE SERVICES who will contact you via email or phone

Who are you visiting?

When is your visit?

Have you travelled from any country outside the UK in the last 10 days? We don't need to know if you travelled more than 10 days ago

Yes

No

If your answer is yes, please state which country and where

Country

Area/Province/State

Have you been in close contact to someone with a confirmed case of COVID-19?

Yes

No

Do you have COVID-19 symptoms, high temperature, continuous dry cough, loss of, or change in normal sense of taste or smell?

Yes

No

Are you experiencing any symptoms of poor health? (e.g. headache, body ache, fatigue etc.)

Yes

No

If your answer is yes, please list symptoms

Optional question - Are you fully vaccinated (2 doses)?

Date form completed

Please click below to confirm you have read and understood the information and the conditions of your visit

I understand the conditions of the Sigma visit ON OFF

Thank you for completing this form.
If we have any concerns about the information given we may contact you before your visit to discuss the details, and may ask you not to visit at this time.
If any details change please contact your host to let them know.
We appreciate your cooperation.

Sigma privacy policy https://www.sigmaplc.com/privacy-policy/

Visitor COVID-19 ChecklistPre-meeting checklist