Grain Craft Visitor Health Questionnaire

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Name *

First

Last

Phone

Company *

Which Grain Craft location are you visiting? *

Date of visit *

Reason for visit *

Within the last 14 days, have you come into contact with or been exposed to someone with a suspected or confirmed case of COVID-19 either through personal contacts or travel? *

Are you experiencing flu symptoms today? (e.g. fever, coughing, shortness of breath, sore throat) *

Upon a return visit to Grain Craft facilities, I agree to share any updates to my risk exposure details such as personal contact, travel to high risk areas, or visits to a hospital where COVID-19 is being treated. *

I agree