Falcon Plastics / Poly-Cast (Pre-Visit) Visitor Questionnaire

To prevent the spread of COVID-19 and reduce the potential risk of exposure to our workforce and visitors we are conducting a simple screening questionnaire. Your participation is important to help us take precautionary measures to protect you and everyone in this building. Thank you for your time.

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Visit Falcon during COVID-19

Visitors Name*
First Last
Personal Phone Number (mobile/home)*
Visitor Company Name / Organization*
Name of Falcon Host*
First Last
Falcon Facility to be Visited*
Date of Visit*
MM slash DD slash YYYY
Have you returned from travel outside the US in a level 3 or 4 risk area in the last 10 days?*
- Yes
- No
Have you had close contact with or cared for someone diagnosed with COVID19 within the last 10 days?*
- Yes
- No
Have you been in close contact with anyone who traveled in the last 10 days outside the US in a level 3 or 4 area?*
- Yes
- No
If the answer is “YES” to Questions 1 - 3, you are not allowed into the facility unless you are fully vaccinated. Enter last date of last shot here to request fully vaccinated status:
MM slash DD slash YYYY
Consent*
I agree that I answered each question truthfully, understanding that a "Yes" to any of the questions, without being fully vaccinated, will result in my access to the facility being denied.

Your access to the facility is allowed with the understanding that you will adhere to the following:

You are NOT experiencing any unexplained symptoms such as a sore throat, fever, respiratory illnesses, etc. that may be spread to others.
Wash your hands with soap and water or use hand sanitizer before entering additional workspaces.
Wear a face covering at all times unless you are fully vaccinated. (if you need an accommodation, please alert the screener and they will connect you with our Workforce Coordinator.)
Practice social distancing, sit or stand at least 6 feet from others unless you are fully vaccinated,
Do not shake hands, hug people, fist bump, or another contact with others unless you are fully vaccinated.
Do not share food or drinks,
Contact your host or other Falcon representative and leave immediately if you start to feel feverish or develop any symptoms during your time at our facility.

updated 6/21/2021

Falcon Plastics / Poly-Cast (Pre-Visit) Visitor Questionnaire

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