Staff Site Access Form - SMARTPLY copy

Uw contactgegevens

Voornaam

Achternaam

E-Mail

MEDITE/SMARTPLY Contact Name

The contact name is that of the individual who gave authorisation for site visit.

Bedrijfsnaam

Visit Date

On what day do you intend to visit the plant?

Have you been in contact with any confirmed Covid 19 cases within the last 14 days?

Yes

If yes, please outline when

Have you been in contact with any suspected Covid 19 cases within the last 14 days, including people in self isolation?

Yes

If yes, please outline when

Have you suffered within the last 14 days, or are currently suffering from any of the following symptoms?

Fever, Cough, trouble breathing or shortness of breath

Yes

If you are travelling to Ireland from another country, please note the following requirments:

The EU Digital COVID Certificate (DCC) is accepted for entry for travel originating within the EU / EEA.
If you have valid proof of vaccination (such as a valid DCC) or that you have recovered from COVID-19 in the past 180 days, no travel-related testing is necessary.
If you do not have valid proof of vaccination or recovery, you will need to present evidence of a negative RT-PCR result from a test taken within 72 hours prior to arrival into the country. No further travel-related testing is necessary.
A completed electronic Passenger Locator Form.

The latest advice on entry to Ireland can be accessed through the following links:

https://www.gov.ie/en/publication/77952-government-advice-on-international-travel/#travelling-to-ireland

https://www.dublinairport.com/covid-19/covid-19-travel-advice

Terms & Conditions

I consent to MEDITE SMARTPLY collecting and storing my data from this form.

I declare that all information in the above is my own and accurate and not on behalf of anyone else.