PRE-EMPLOYMENT QUESTIONNAIRE FOR PERSONNEL WORKING IN FOOD PRODUCTION PRE-EMPLOYMENT QUESTIONNAIRE

Yes No Yes No Yes No Yes No

Employee Name, Surname:

Employee Signature:

Company:

Date:

  1. Have you had diarrhea and/or vomiting currently or within the last seven days?
  2. Do you currently have any of the following complaints?
    • a) Skin problems affecting your hands, arms, and face?
    • b) Bullae (blisters), stye, or infected finger?
    • c) Discharge from eyes, ears, or gums/mouth?
  3. Do you have any of the following complaints?
    • a) Recurrent skin or ear problems?
    • b) Recurrent intestinal disease (e.g., colitis)?
  4. Do you have any food allergies or intolerances?

I accept and declare that the information I have provided above is correct.

Form No: PRE ISIS_Food_Safety_Forms_2019