COVID-19 Screening Questionnaire

Welcome to Copper Fibre Africa

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Please complete this form for each employee or visitor on a daily basis.

Please fill out all required fields.
First name *
Last name *
Phone *
Date Completed
Has anyone in your family traveled overseas in the last 2 weeks?
Do you have sanatizer and face mask on hand?
Do you have a fever?
Do you have a sore throat?
Do you have a cough?
Do you have shortness of breath?
Are you an employee of Copper Fibre Africa?
If you are a visitor, what is the purpose of your visit?
My current temperature is *
Temperature taken by *
I agree with the privacy policy and confirm that my personal information may be used in accordance with the law *
* required fields

Telephone Number:

+2787 152 0459

Direct Email:

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