"COVID-19" questionnaire

Add to Bookmarks

The health and safety of our employees has top priority at ENGIE. We therefore ask you as a visitor to fill out this health questionnaire as part of our preventive measures to contain the coronavirus (COVID-19). You are required to answer these questions truthfully. ENGIE reserves the right to refuse you a visit if the facts are relevant.

First name and last name

Phone number

Company

Date of visit

Question 1: Do you have acute respiratory symptoms (i.e. symptoms such as fever, cough, sore throat and/or difficulty breathing)?

Yes

Question 2: Does a person close to you who lives in the same household suffer from fever, cough, shortness of breath and/or loss of sense of smell and/or taste?

Yes

Question 3: Have you or have you had, contact with a confirmed case of COVID-19 in the last 14 days?

Yes

Question 4: Have you been in a risk area in the last 14 days?

Yes

CAPTCHA

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.