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Construction Site Covid-19 Protocol Form
Please fill the form below
1
Step 1
2
Step 2
*
Site Address/Location:
This field is required.Please enter value
Date sign-in:
This field is required.Please enter value
Date format is invalid, please check it again
The value must be greater than or equal to -21474836487
The value must be less than or equal to 2147483647
Company Name:
This field is required.Please enter value
Time sign-in:
This field is required.Please enter value
The value must be greater than or equal to -21474836487
The value must be less than or equal to 2147483647
*
Full Name:
*
First Name
*
Last Name
This field is required.Please enter value
This field is required.Please enter value
Email Id:
This field is required.Please enter value
Please enter valid email address
Mobile No:
This field is required.Please enter value
Invalid phone number.
The value must be less than or equal to 20
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People you travelled with:
This field is required.Please enter value
Have you had any Covid-19 symptoms: Fever over 38 degrees, dry cough, shortness of breath:
Yes
No
This field is required.Please enter value
Are you feeling unwell:
Yes
No
This field is required.Please enter value
Have you been in contact with someone with COVID-19 symptoms:
Yes
No
This field is required.Please enter value
Planned destination after leaving this site:
This field is required.Please enter value
Please confirm that you have received site induction from Apex Construction (Nelson) Ltd:
Yes
No
This field is required.Please enter value
Have you arrived in New Zealand in the past 14 Days:
Yes
No
This field is required.Please enter value
Signature:
This field is required.Please enter value
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