Covid - Visitor Pre-Arrival Health Screening Questionnaire

Title *

Full Name(s) *

Company / Organisation (if applicable)

Telephone *

Email *

Date of Visit

Purpose of Visit *

Showround Appointment
Sales Appointment
Supplier
Contractor
Other

Who Are You Visiting? *

It is important that you complete the following Covid19 based questions prior to arrival. If you, or anyone in your household, has experienced any of these symptoms or you have been advised to self-isolate, please contact a member of the team on 01325 729999 to discuss your upcoming reservation.

In the last 10 days have you, or anyone in your household, been asked to self-isolate? *

Yes
No

In the last 10 days have you, or anyone in your household, experienced a high temperature (meaning that you are hot to touch on your chest or back); a loss or change to your sense of smell or taste or a new, continuous cough? *

Yes
No

Have you travelled overseas within the last 10 days? *

Yes
No

If you answered 'yes' to the previous question, if you have returned from a country on the amber or red list, please confirm the dates on which you returned and the date your quarantine period ended

Please confirm that you have passed on all information provided by rockliffe hall to everyone in your party so they are aware of guidelines in case they develop COVID-19 symptoms. *

I have
I have not

In confirming this reservation I acknowledge that the measures implemented by Rockliffe Hall to mitigate the transmission of COVID-19 place personal responsibility on me for adhering to the requirements including, but not limited to, those relating to social distancing, personal hygiene, testing and reporting health issues, self-isolating and quarantining in accordance with government guidelines. I accept that these provisions are required to protect the health and wellbeing of me, my family, fellow guests and team members at Rockliffe Hall. I understand that failure to comply with any of these requirements is a serious matter and may result in me being requested to leave the Rockliffe Hall resort. *

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