Medical Screening for Food Handlers NUMBER: 058 DOC GRO-Q DATE PREPARED: 9/10/2019 PAGE: 1 of 1Name Position At present, or in the last seven days, are you suffering or have you suffered from: Temperature greater than 38°C, cough, difficulty breathing or other symptoms of COVID-19. Yes NoDiarrhoea and/or vomiting? Yes NoStomach pain, nausea or fever? Yes NoSkin infections of the hands, arms or face. For example, boils, styes, septic fingers, discharge from eye I ear I gums I mouth. Yes NoJaundice (yellowing of the skin or eyes) Yes NoHave you ever had typhoid or paratyphoid fever or are you now known to be a carrier of Salmonella Typhi or Paratyphi. Yes NoAre you a carrier of any type of Salmonella? Yes NoIn the last 6 weeks, have you travelled overseas? Yes NoIn the last 6 weeks, have you travelled overseas? Yes NoIf yes, Countries visited in the last 6 weeks: In the last 21 days have you been in contact with anyone at home or abroad, who may be suffering from a food-borne disease? Yes No Your information will remain confidential and is only used to assess your health risk to our operations.Date Signature Sign Here Management Action Taken: Last Update: 22/03/2020 Version: 2 Authorised: Troy MarlandUncontrolled if printed. Please check current status against document registerSubmit Form
