COVID-19 Questionnaire

The safety of our staff and visitors is RSPCA Radcliffe Animal Centre's top priority.

To prevent the spread of COVID-19 and reduce the potential risk of exposure to our staff and visitors, we are
conducting a simple screening questionnaire.

Your participation is important to help us take precautionary measures to protect you and everyone on this site.

Thank you for your time.

Visitor's Name (required)

Visitor's Email Address (required)

Visitor's Phone Number (required)

Have you returned from abroad in the last 14 days
NoYes

If "Yes" please tell us which country you visited

Have you had close contact with or cared for someone diagnosed with COVID-19 within the last
14 days?
NoYes

Have you experienced any cold or flu-like symptoms in the last 14 days (to include fever, cough,
sore throat, respiratory illness, difficulty breathing)?
NoYes