Offsite Meeting COVID-Safe Questionnaire The safety of our clients, team members, suppliers, families and visitors remains our top priority at Aintree Group. As the COVID-19 outbreak continues to evolve and spread, we are closely monitoring the situation and will periodically update our policies and procedures based on current recommendations from the Australian and Victorian Governments and the World Health Organization. To prevent the spread of COVID-19 and reduce the potential risk of exposure to our team members, clients and the wider community, we are conducting a simple screening questionnaire (below). Our team members who are visiting clients have passed this screening questionnaire prior to their arrival. Your participation is important to help us take precautionary measures to protect you and everyone in this office. We appreciate your cooperation and honesty in this matter. Aintree Group Team Members, please confirm:* This meeting has been approved by Shane and/or Linda.Please get approval for this meeting before sending the screening questionnaire to your meeting host. Thank you for confirming. TEAM MEMBERS: Please click "Submit to Meeting Host" at the bottom of the questionnaire, and enter your visitors email address for them to receive and complete the screening questionnaire. MEETING HOSTS: Please complete the screening questionnaire below and then click "Complete Questionnaire" to submit. Screening Questions - Meeting Host to CompleteThis questionnaire is to be completed by the meeting host before an Aintree Group team member enters the premesis.Host Name:* First Last Host Mobile Number:*Host Email Address:* Company/Organisation:*Industry:*Please specify if you work in the following industries: hospital, health care, aged care, airline or emergency services. Name(s) of Visitor(s)*Please provide the name(s) of the Aintree Group team member(s) attending the meeting on your premisis.Names of all other meeting attendees:*Meeting Location* Business Name Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Date of Meeting:* Date Format: DD slash MM slash YYYY Meeting Start Time:*Estimated Meeting End Time:*Have you, or any other meeting attendee, returned from overseas in the last 14 days?*YesNoHave you, or any other meeting attendee, been in close contact with someone who has returned from overseas within the last 14 days? Including members of household or workplace*YesNoHave you, or any other meeting attendee, had close contact with or cared for someone diagnosed with COVID-19 within the last 14 days? Including members of household or workplace*YesNoHave you, or any other meeting attendee, experienced any cold or flu-like symptoms in the last 14 days?*Including: fever, cough, sore throat, respiratory illness, difficulty breathing.YesNoHave you, or any other meeting attendee, been in close contact with someone who has experienced cold or flu-like symptoms as described above? Including members of household or workplace.*YesNoAre you, any other meeting attendee, or one of your / their household members or co-workers, awaiting results of a COVID-*YesNoWhat are the procedures in place to prevent the spread of COVID-19 in your workplace, including precautions being taken in*Self-Declaration* I declare that the information given in the questionnaire above is correct.Date Signed:* Date Format: DD slash MM slash YYYY Based on your responses to the questionnaire, you will not be able to conduct your meeting in person. Please click the "Complete Questionnaire" button below and someone will be in touch to arrange a virtual meeting instead.Please click the "Complete Questionnaire" button below. Thank you for taking the time to ensure everyone's safety.
