JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
COVID-19 Outbreak Management Tier 1 Checklist for Workplaces (Other- Pharmacy)
see COVID-19 Public Health Action Checklist for Workplaces on Business Continuity Plans. This form will also notify your local public health team
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Date form submitted
*
MM
/
DD
/
YYYY
e-mail address
*
address of the affected setting
Your answer
Contact details
*
Name: Position: 'Phone Number:
Your answer
Details of Staff
*
Total number of staff, Number of staff in at one time
Your answer
Size and Layout of Workplace
*
Including number of rooms, workspace areas 2m apart, number floors, sharing with different businesses, details of toilet/bathroom facilities, communal areas, details of handwashing facilities, etc
Your answer
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
