Visitor Access Request

1. Do you have a Cough or Shortness of breath?*
2. Please indicate if you have any of these symptoms:
- Chills
- Repeated shaking chills
- Headache
- New loss of taste or smell
- Diarrhea
- Fever
- Muscle pain
- Sore throat
- Vomiting
3. Are you or any members of your household currently awaiting test results for COVID-19?*
4. Have you been in facilities or locations with recognized COVID-19 cases?*
If you answered Yes to any of the above, please re-arrange your visit after you have self-isolated for 14 days or get a doctor’s clearance certificate.
Requirements of entry.*
On entering the building, you are required to use the combined hand sanitiser dispenser and non contact thermal check. The unit is located on the wall at the first landing of the stairwell going up to the office. If your temperature is over 37.5 you must immediately leave the premises.

Always remember to adhere to the 1.5mtr social distancing guidelines.
I agree to these requirements
Person you are visiting*
Person you are visiting's name (other)*
Person you are visiting's e-mail address*
Please provide the e-mail address for the Priestley's staff member you are visiting.
Date of Visit*
Your access will only be valid for this date. If you reschedule your visit for another date, you will need to resubmit this form.
DD slash MM slash YYYY
Your Name*
Your Company*
Phone number*
E-mail Address*
Your access details will be sent to this address. Please ensure it is valid and that you have access to this address, or you will need to re-submit your request.
Comments
This field is for validation purposes and should be left unchanged.

	Free from:	May contain:
Barley
Cereals containing gluten
Egg
Lupin
Milk
Oats
Peanuts
Rye

	Free from:	May contain:
Sesame seeds
Soybeans
Spelt
Sulphites
Tree nuts
Wheat
Soybean
Tree Nut Products

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Visitor Access Request