PSO 5000 - Inside Time

PSO 5000 ANNEXES Page 15Staff/Visitors' Food Safety Health QuestionnaireANNEX 10Name:Address:____________________________________________________________________________________________________Occupation:Department:__________________________________________________1. Have you suffered from sickness, diarrhoea or any stomach disorders within the last 7 days?YES/NO2. Have you suffered from any 'flu-like' symptoms during the last 48 hour period?YES/NO3. Have you recently been in contact with anyone suffering from any of the following –cholera, dysentery, gastro-enteritis, typhoid paratyphoid, or salmonella infection?YES/NO4. Are you suffering from any infectious conditions of the skin, nose, throat, eyes or ears?YES/NO5. Have you been abroad within the last 3 months?YES/NOIf yes, please state where:________________________________6. Have you suffered from any of the above conditions during or since your return from leave?YES/NOI agree that the above-mentioned statement is true to the best of my knowledge.Signature:(Officer/Visitor)Date:Signature:(Duty Catering Manager)Date:Issue No. 294 issue date 09/04/08