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CSIR COVID-19 Screening App for Contractors

Dear Contractor

On 15 March 2020, President Cyril Ramaphosa announced a national state of disaster to enable the introduction of measures to combat the spread of COVID-19 in South Africa. As the CSIR, we wish to implement the health precautionary measures in accordance with the Department of Employment and Labour Regulation 43257.

We require you to fill out the below questionnaire to assist in determining if you will be allowed to access the CSIR premises to conduct business, this will allow the CSIR to provide a safe and healthy work environment for everyone.

In line with the guidelines for coronavirus risk identification as set out by the National Institute of Communicable Diseases (NICD), we kindly request that you complete the following questionnaire:

 

* : Field that have the asterik are mandatory

Personal Information
(This question is mandatory)
Name:
(This question is mandatory)
Surname:
(This question is mandatory)
Do you have a South African ID?
(This question is mandatory)
ID Number:
(This question is mandatory)
Passport Number:
(This question is mandatory)
Contact Number:
+27
(This question is mandatory)
Email Address:
Please enter your email and line- managers' email, for example, contractor@csir.co.za;linemanager@csir.co.za
(This question is mandatory)
Name of organisation:
(This question is mandatory)
Building(s)to be visited:

Provide building(s) number

(This question is mandatory)
CSIR Department you are working with:
Informed Consent Notice
(This question is mandatory)

This Screening Tool is offered for informational purposes to help you check for COVID-19 symptoms as required by the Department of Labour Workplace COVID-19 regulations.

The guidance you receive depends on the accuracy of the information you provide as well as current guidelines for identifying symptoms associated with COVID-19.

Based on your self-reported answers, the tool will provide a response to be used by the CSIR.

Please take the survey prior to entering the CSIR premises and display the response to Security at the entrance gate in accordance with the CSIR COVID-19 precautionary measures.

All medical information will be kept confidential and no Personal or Special Personal Information will be shared with any other external parties.

This is not a substitute for professional medical advice, diagnosis, or treatment of disease or other conditions, including COVID-19. Always consult a medical professional for serious symptoms or emergencies.

This disclaimer and Informed Consent Notice must only be accepted once, but the screening tool must be completed every time you want to access the CSIR premises.

Refusal to accept the disclaimer and Informed Consent Notice, will result in access to CSIR sites being denied.

By clicking “AGREE” below, you indicate that you have reviewed and agree to the above disclaimer and our Informed Consent Notice, available here:

CSIR COVID-19 Symptom Screening Tool - Informed Consent Notice.
 
ID number on  hereby:
Risk Identification
(This question is mandatory)
In the last 14 days were you in close/direct contact with either a confirmed or probable case of Covid-19 infection?
(This question is mandatory)
Have you worked in or been to a healthcare facility treating people with Covid-19 in the last 14 days?
(This question is mandatory)
Do you currently have any flu-like symptoms - including fever, persistent cough, shrtness of breath/difficulty breathing, sore throat, runny nose, loss of taste and or loss of smell?
(This question is mandatory)
Did you have a laboratory exposure to biological material (i.e. primary clinical specimens, virus culture isolates) known to contain COVID-19?
(This question is mandatory)
Have you attended a funeral in the last five days?
Disclaimer
(This question is mandatory)

I hereby declare that the information provided above is true and correct.  I also understand that any willful dishonesty could result in me placing the CSIR site occupants at risk.  I furthermore understand and agree that by answering yes to any of the above questions, my access to the CSIR site will be temporarily denied and deferred until a suitable isolation period has passed.

Screening Results

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