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

Employee Name, Surname:
Employee Signature:
Business:
Date:

  1. Have you had diarrhea and/or vomiting complaints currently or within the last seven days?

    Yes No

  2. Do you currently have any of the following complaints?

    • a) Skin problems affecting your hands, arms, and face?
    • b) Bullae (water blisters), stye, or infected finger?
    • c) Discharge in the eye, ear, or gums/mouth?
    Yes No

  3. Do you have any of the following complaints?

    • a) Recurrent skin or ear problems?
    • b) Recurrent intestinal disease (e.g., colitis)?
    Yes No

  4. Do you have any food allergies or intolerances?

    Yes No

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

Form No: PRE ISIS_Food_Safety_Forms_2019