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.

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.

Name

This field is for validation purposes and should be left unchanged.

	Free from:	May contain:
Cereals containing gluten
Egg
Milk
Oats
Soybeans
Sulphites
Tree nuts
Wheat

	Free from:	May contain:
Barley
Lupin
Peanuts
Rye
Sesame seeds
Soybean
Spelt
Tree Nut Products

Orange & Almond Cake

Citrus Tart – large

Deep Dish Apple Pie

Blueberry Brulee Cheesecake

Hummingbird Cake

Pavlova Hi Rise Mini 27g

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