Temporary Labour Health Check

This is to protect all Imprint staff from the risk of infection from Covid -19.
This must be completed by the agency supplying temporary labour.
This form must be emailed to imprint once completed, before supplying labour to our sites.

NOTE: If you are not able to certify to the statements in this Health Declaration, you must not arrive on-site, as we will not allow you to work on any of Imprints premises.

IN THE PAST 14 DAYS, THIS PERSON HAS NOT: Travelled from any international location or have been in close contact with someone who has returned from ANY international locations. (Please follow government guidance on quarantine)

IN THE PAST 14 DAYS, THIS PERSON HAS NOT: had contact with a suspected or confirmed case of coronavirus (COVID-19), or a person under monitoring for Coronavirus.

IN THE PAST 14 DAYS, THIS PERSON HAS NOT EXPERIENCED:
• High temperature – this means you feel hot to touch on your chest or back (you do not need to measure your temperature)
• A new, continuous cough – this means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours (if you usually have a cough, it may be worse than usual)
• Loss or change to your sense of smell or taste – this means you have noticed you cannot smell or taste any-thing, or things smell or taste different to normal.

Agency Name

Name of Temporary Employee

First Last

Completed by

Date

Signature