Bulmers Project Health Form - Docusafe

Bulmers Project Health Questionnaire

To be completed by all contractors, operatives, employees and visitors coming onto the Bulmers site.

Step 1 of 2

To be filled out by any visitor or contractor that will visit a production area, and any employee returning from holidays from countries mentioned in Q4:
ALLERGENS: Note: Sulphites (S02) is used as a preservative in cider production areas in this facility. Gluten derived from wheat and cereals is used in the Brewery onsite (See Doc; 27 10 in reception.) YOU ARE NOT PERMITTED TO BRING IN ANY OTHER ALLERGENS ON-SITE

Health

Are you currently suffering from any of the following:
Respiratory Symptoms?
(Cough, high temperature, shortness of breath, difficulty breathing)
Diarrhoea?
Vomiting?
Jaundice?
Sore throat with fever?
Lesions containing pus on the hand, wrist or exposed body part?
(Such as boils and infected wounds, however small)

High Risk Conditions

1. Have you been exposed to, or suspected of causing a confirmed outbreak of Typhiod fever, Shigellosis (Shigella spp.), Escherichia coli 0157:57 infection (E. coli 0157:H7), or Hepatitis A?
2. Do you live in the same household as a person recently diagnose with typhoid fever, Shigellosis, Hepatitis A or illness due to E.coli 0157:H7?
3. Do you have a household member attending or working in a setting where there is a confirmed outbreak of typhoid fever, shigellosis, E.coli 0157:H7 infection or hepatitis A?
4. Have you been travelling outside of Ireland in the past 30 days?
5. Have you worked in production areas of any other food production facilities in the last week?
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