Covid-19 employee/visitor form for 2021:

Covid-19 Health Declaration

How are you feeling today?

First Name

Last Name

Email

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

I am not experiencing the symptoms: fever, cough, sore throat , loss of smell or shortness of breath.

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

I will sanitize and keep social distnace throughout the day and wear mask if the social distance must be broken.

Initials

Date

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

Capital investment initiatives in this company are co-funded by the European regional development fund and enterprise Ireland under the board, midland and western regional operational programme 2014-2020.

contact us

Unit 2, Templemichael Business Park, Balinalee Road, Longford.

Mail: info@nandeprecision.com

Tel: 00353-43-3362100

GET A QUOTE

Covid-19 employee/visitor form for 2021:

Covid-19 Health Declaration

contact us

Menu