Covid-19 screening

COVID19 Virus Screening Questions

Visit date

Mobile number

First Name

e-mail adress

Last name

Contact name NFGD

The following are questions that need to be answered by all visitors prior to entering NFGD’s site.

1. Did you in the past 7 days, or do you now, experience any of the following symptoms: fever, cough, sore throat or a cold?

Yes

2. Do you live with anyone who has experienced any of the following symptoms in the last 7 days? fever, cough, sore throat or a cold? (examples: family members, roommates)

Yes

3. Have you been in close contact with anyone who diagnosed with COVID-19 in the last 14-days

Yes

4. Did you visit or reside in a country outside of the Netherlands in the last 14-days?

Yes

*In this form NFGD obtains travel history of visitors. This information will be used by NFGD for the purpose of preventing the spread of the COVID-19 virus. The information obtained shall not be used for any other purposes and will be destroyed within 7 weeks after completion of the form