Client/Visitor Questionnaire

As part of the Re-Opening-Guidelines and Return to Work Safely Protocols which has been designed to support employers and employees to put measures in place that will prevent the spread of COVID-19 in the workplace we ask that you complete the following questionnaire prior to your appointment.

Please complete the Client/Visitor Covid-19 Questionnaire online or download a copy and bring with you to the appointment.

Sebastian Marks Client/Visitor COVID-19 Questionnaire

Please leave blank:

Name:

Address:

Email:

Contact Number:

Stylist/ Beautician:

Date of Appointment:

To ensure the Safety & Health of all people interacting with Sebastian Marks, clients and visitors must complete this declaration form prior to entering or on arrival our salon. If you indicate to us you have symptoms of COVID-19 OR you have been abroad in the last 14 days with exception to Northern Ireland you will be required to either restrict your movements or self-isolate. Where this is the case, you are prohibited from entering the salon and advised to seek professional medical help/assistance in line with HSE Guidelines.

1. Have you visited any of the countries outside Ireland excluding Northern Ireland?

Yes

2. Are you suffering any flu like symptoms?

Yes

3. Are you experiencing any difficulty in breathing, shortness of breath?

Yes

4. Are you experiencing any fever/temperature symptoms?

Yes

5. Did you consult a Doctor or other medical practitioner?

Yes

6. How are you feeling Healthwise?

Well

Unwell

7. Have you been in contact with someone who is confirmed to have COVID-19 or has visited an affected region in the past 14 days?

Yes

NOTE: When in salon, please adhere to our in-salon standard processes/procedures regarding infection control, i.e. hand washing/hand sanitising and general coughing/sneezing etiquette?

Signature:

Date:

Download Form