COVID 19 Jobsite Visitor Questionnaire Checklist

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All organizations must screen every visitor during the COVID-19 pandemic. A visitor could be an active carrier of the virus. Every visitor should fill in all their details so that in case of outbreak the contact tracing becomes easier. COVID-19 Jobsite Visitor Questionnaire is used to collect all the data from every visitor. It checks if all COVID-19 norms are followed by every visitor.

General

Inspection area

Location

Area Id

Is the hand wash area clean?

Yes No Na

Does the area have soap and single-use napkins?

Yes No Na

Is sanitizing solution available in all areas?

Yes No Na

Is sanitizer concentration as per the need?

Yes No Na

Is hand sanitizer stocked up?

Yes No Na

Is hand wash direction displayed?

Yes No Na

Is hand washed properly?

Yes No Na

Is everyone wearing gloves?

Yes No Na

Are employees wearing a hair covering caps?

Yes No Na

Is the hand wash sink used for washing hands?

Yes No Na

Are nails trimmed and clean?

Yes No Na

Are employees wearing minimal accessories or jewelry?

Yes No Na

Are employees eating and drinking in the work area?

Yes No Na

Are employees wearing a proper uniforms?

Yes No Na

Are employees covering their faces while sneezing or coughing?

Yes No Na

Are all wearing proper PPE?

Yes No Na

Are injuries properly bandaged?

Yes No Na

Are proper industry shoes worn?

Yes No Na

Are eye protections worn if necessary?

Yes No Na

Are industry gloves worn when dealing with heavy items?

Yes No Na

Sign off

Employee interviewed

Supervisor of the unit -name

Supervisor of the unit -signature

SIGNATURE

Date

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COVID 19 Jobsite Visitor Questionnaire Checklist

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