COVID 19 - Visiter Questionnaire

The safety of our employees, suppliers, contractors, families and visitors remain Littler Machinery Ltd's overriding priority. As the coronavirus COVID-19 outbreak continues to evolve and spread globally, we are monitoring the situation closely and will periodically update company guidance based on current recommendations from the UK government. Only business critical visitors are permitted at Litter Machinery at this time. To prevent the spread of the COVID-19 and reduce the potential risk of exposure to our workforce and visitors, we are conducting a simple screening questionnaire. Your participation is important to help us take precautionary measures to protect you and everyone at Littler Machinery Ltd. We kindly ask all visitors to participate in this precautionary measure to protect you. This questionnaire should be completed in advance of any planned visit. Thank you for your time.

Name:*

First Last

Contact Number:*

Email*

Company Name:*

Reason for Visit:*

Date of Appointment:*

SELF - DECLARATION BY VISITOR

1. Have you or a family member you live with returned/entered the UK from overseas within the last 14 days?*

YES
NO

If 'YES' State from what country

2. Have you been in close contact with or cared for someone who is diagnosed with COVID-19 within the last 14 days?*

YES
NO

3. Have you had close contact with or cared for someone diagnosed with COVID-19 within the last 14 days?*

YES
NO

4. Have you displayed flu-like or symptoms of COVID-19 virus including, persistent cough, fever, sore throat, respiratory illness, difficulty in breathing or loss of smell or taste in the last 14 days?*

YES
NO

Have you had the COVID-19 Virus?*

YES
NO

Consent*

I have read and understand our privacy policy.

Privacy Notice: Visitor COVID-19 Questionnaire
Last updated on 07 October 2020

Data controller
For the purposes of data protection laws, Littler Machinery Ltd is the data controller of your personal data collected in this questionnaire. This means that we are responsible for determining the purposes and means of processing that data.

How to contact us
If you have any questions, comments or complaints in regard to how we use your personal data, or if you would like to exercise your data protection rights, please contact our Data Protection Lead, Sherie Hartill, at admin@littlermachinery.co.uk or by post to: Data Protection Lead, Littler Machinery Ltd, Unit 90 Stephenson Way, Formby Business Park, Formby, Merseyside, L37 8EG

How and why we will use your information
We are responsible for ensuring the safety of our employees as well as visitors attending our offices. This includes taking reasonably practicable measures to protect them from risks to their health at our premises. We are also committed to supporting the Government’s efforts to curb the spread of COVID-19 in the UK as far as it is consistent with our obligation to keep information belonging to our clients confidential. The purpose of this questionnaire is to reduce the risk of transmission of COVID-19 at our premises. Your co-operation with us in this matter is important to achieving this aim.

We respect your privacy and, under normal circumstances, we would not be asking you for this information. We have taken the following measures to minimise the intrusion in your privacy:

• You are not obliged to complete this questionnaire. If you prefer not to do so, we ask that you reschedule your appointment or ask us to arrange a telephone phone or a video appointment for you – but you do not need to tell us your reasons for that.

• You have the right to withdraw your consent to our use of your information collected in this questionnaire at any time by contacting our Data Protection Lead (see the details above).

• We ask you to return the completed questionnaire to this questionnaire. It will not shared this information with other staff. The only information that we would pass to them is that the proposed appointment in our office can go ahead or that you asked for your appointment to be postponed or held by phone or a video meeting.

• We will not share this information with any third parties.

• We will only keep this information for up to 21 days.

Your data protection rights
In addition to the right to withdraw your consent at any time, you also have the following rights:
• access: the right to receive a copy of the personal data we hold about you and to check that we are lawfully processing it;
• rectification: the right to require us to correct any inaccuracies in your personal data;
• erasure: the right to require us to delete personal data in certain situations; and
• restriction of processing: the right to require us to restrict processing of your personal data in certain circumstances (e.g. if you contest the accuracy of the data we hold).

The Data Protection Legislation also gives you a right to lodge a complaint with the Information Commissioner, who may be contacted at https://ico.org.uk/concerns, by telephone on 0303 123 1113, or by post to: Information Commissioner’s Office, Wycliffe House, Water Lane, Wilmslow, Cheshire, SK9 5AF. We would, however, appreciate the chance to deal with your concerns before you approach the ICO, so please contact us in the first instance.

For us to facilitate any meeting on site the following must be adhered to*

I will adhere to a 2 metre social distancing whilst on site
On arrival will participate in a temperature check.

Please check all boxes to let us know you have read and agree to these temporary COVID 19 safety procedures.

Signed (Print name)*

COVID -19 VISITOR QUESTIONNAIRE

SELF - DECLARATION BY VISITOR

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