Visitor Slip & Health Declaration

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Visitor Slip

Gate Pass No: {{ formatted_gate_pass_number }}

Visitor Type: {{ visitors_type }}

Name: {{ visitors_name }}

Address: {{ visitors_address }}

Mobile No: {{ visitors_mobile }}

Chk In Date & Time: {{ check_in_time }}

Chk Out Date & Time: {{ check_out_time }}

To Meet: {{ employee_name }}

Company Name: {{ company_name }}

Department: {{ department_name }}

Location: {{ location_name }}

Sign Of Visitor

Sign Of Meeting Person

Sign Of Security Officer

Visitor Health Declaration

OXYGEN LEVEL ____________________ PULSE RATE ____________________ TEMPERATURE ____________________

Questions		Answer	Remark
1. Do you have any contagious disease?		Yes / No
2. Are you suffering from cold, cough, fever, diarrhoea or vomiting?		Yes / No
3. Have you been in contact with the person who had flu?		Yes / No
4. Have you been in contact with a known case of COVID-19 or have symptoms within the last 14 days prior to visit? Symptoms include but are not limited to: ● Fatigue Cough Shortness of breath ● Body aches Sore throat Fever
You are requested to cooperate before entering the plant by following our protocols. ● Please wear cap, hair net, apron, mouth cover / mask and gumboot (if necessary). ● Please do not carry any food item inside the plant and submit it at the security gate.
Security Officer / Supervisor Comments:		Visitor Allowed to visit (Yes / No):