COVID-19 Survey

COVID-19 Survey

The purpose of this survey is to minimize the spread and transmission of infectious disease (E.g. COVID-19) from all Legeneering work divisions which include both onshore and offshore facilities and proactively keeping our work teams safe at all times. To assist in this objective, could staff please ensure they answer the questions below truthfully, Thank you.

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* 1. Date

Date / Time

Date

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* 2. Name

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* 3. Have you been in close contact with a person confirmed as having a case of COVID-19?

Yes

No

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* 4. Have you returned from an international or interstate location and entered Western Australia?

Yes

No

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* 5. Are you living or staying with a person who has traveled from anywhere outside Western Australia in the last 14 days?

Yes

No

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* 6. Are you currently experiencing any of the following symptoms?

Coughing

Sneezing

Sore Throat

Headache

Difficulty breathing

All of the above

None

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* 7. I declare that I have answered the above questions truthfully.

Yes

No