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2020YR-2021YR COVID-19 Screening
Screening Checklist of client and vehicle
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* Indicates required question
Safety Is the key of our Health
Name
*
Your answer
Mobile number
*
Your answer
Did you wash your hands or used antiseptic which is kept by workshop?
*
Yes
No
Required
Vehicle Status with Workshop
*
Pre Lock Down
Post Lock Down
Required
Have you covered your face by using mask before entering the workshop premises?
*
Yes
No
Required
Which of the following symptoms do you have?
*
cough
fever
shortness of breathing
Persistant pain in the chest
None of above
Required
Vehicle Registration Number
*
Your answer
Client Temperature before entering Workshop
*
Your answer
Before Login First Sanitation of vehicle - Regular Washing (Liquid SOAP BASED)
*
Yes
No
Required
Before Login Second Sanitation of vehicle - Sodium Hypochlorite (NaOCI) Washing
*
Yes
No
Required
Has the individual contacted with people that were infected, suspected or diagnosed with COVID-19?
*
Yes
No
Required
Client Address in details
*
Your answer
I here by agree to hand over the motorcycle to the shop owner for repairing purpose under my own risk.
*
Yes
Driving License number
*
Your answer
Have you installed Arogya Setu App?
*
Yes
No
Required
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