Visitor Check-in

COVID-19 NOTICE

All visitors and contractors are required to declare their recent travel history and potential exposure to COVID-19 prior to entering the premises.

NOTE: if you have recently returned from overseas you are required by law to self-isolate for 14 days. DO NOT ENTER THE PREMISES. GO HOME.

For enquiries: 03-359 7759 (head office)

For further information and health advice, visit health.govt.nz

Personal details

Name:

Company / Business:

Phone:

Email:

Disclosure

Have you or anyone in your household returned from any international travel in the past 14 days?

If yes, list all locations visited including layovers and transit airports:

Arrival date back in New Zealand:

In the last 14 days, have you or anyone in your household come in contact with a person who has a confirmed case of Coronovirus?

If yes, specify last date of contact:

Symptoms

Do you have any symptoms?

If yes, describe your symptoms: