Visitor Self Declaration Form Visitor Self Declaration Form The safety of our team members, customers, families and visitors remains Syfan Logistics’ overriding priority. As the coronavirus disease 2019 (COVID-19) outbreak continues to evolve and spreads globally, Syfan Logistics’ is monitoring the situation closely and will periodically update company guidance based on current recommendations from the Center for Disease Control and the World Health Organization. To prevent the spread of COVID-19 and reduce the potential risk of exposure to our team members and visitors, we are conducting a simple screening questionnaire. Your participation is important to help us take precautionary measures to protect you and everyone in this building. Thank you for your time. Visitor's Name * Phone Number (mobile/home/business) * Visitor's Company/Organization * Self-Declaration by Visitor If the answer is “yes” to any of the following questions, access to the facility will be denied. 1. Have you returned from any of the countries listed on cdc.gov/coronavirus locations confirmed within the last 14 days? * Yes No 2. Have you had close contact with or cared for someone diagnosed with COVID-19 within the last 14 days? * Yes No 3. Have you been in close contact with anyone who has traveled within the last 14 days to one of the countries listed on cdc.gov/coronavirus locations confirmed? * Yes No 4. Have you experienced any cold or flu-like symptoms in the last 14 days (to include fever, cough, sore throat, respiratory illness, difficulty breathing)? * Yes No Signature (Visitor): * Date * reCAPTCHA Note: If you plan to be onsite for consecutive days, please immediately advise your Syfan host if any of your responses change. If you are human, leave this field blank. Submit Δ
