PVC Safety & Project Operations Plan
COVID-19 Project Safety & Operations - Subcontractor - Jobsite Access
Email *
Project Name: *
Project Address: *
Company Name: *
Employee Name: *
Employee Home Address: *
Employee Phone Number: *
Employee Email Address if Applicable *
History
Have you experienced any symptoms of illness such as coughing, fever, or shortness of breath in the past 14 Days? *
Has anyone in your household experienced any symptoms of illness such as coughing, fever, or shortness of breath in the past 14 days? *
Have you been in close contact (within 6 feet) with anyone who has been diagnosed with COVID-19? *
Have you traveled internationally in the past 14 days? *
Current
Has your body temperature been taken today prior to accessing the site? *
Is your body temperature lower than 100.4 degrees F? *
Do you have all the proper PPE to access this site (face mask, eye shield, gloves)? *
Have you read & understood the PVC COVID-19 Policy? https://bit.ly/2AeorFy *
Signed By: *
Date: *
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A copy of your responses will be emailed to the address you provided.
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