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Entabeni COVID-19 Screening App

Dear Guest(s)

We are looking forward to hosting you at Entabeni. In our support to combat the spread of COVID-19 in South Africa, we wish to implement the health precautionary measures in accordance with the Department of Employment and Labour Regulation 43257.

Please complete the below questionnaire as a screening measure to gain access to Entabeni. This questionnaire needs to be completed before access can be granted and needs to be completed each day you will be visiting Entabeni.

* : Field that has the asterisk are mandatory

Personal Information
(This question is mandatory)
Check-in date
Open the date time chooser
(This question is mandatory)
Name and Surname
(This question is mandatory)
ID number
(This question is mandatory)

Residential address

(This question is mandatory)

Nationality

(This question is mandatory)
Email Address:
(This question is mandatory)
Mobile number
+27
(This question is mandatory)
Office number
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 the answers provided, you will receive a response by email confirming if you may gain access to Entabeni. Please take the survey prior to entering  Entabeni premises and display the response to Security at the entrance gate in accordance with the  Entabeni 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 day you visit Entabeni .

No access will unfortunately be granted if the disclaimer and Informed Consent Notice is not accepted.

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 10 days were you in close/direct contact with either a confirmed or probable case of Covid-19 infection?
(This question is mandatory)
Have you returned from any foreign country with confirmed Coronavirus infections in the last 10 days?
(This question is mandatory)
Have you worked in or been to a healthcare facility treating people with Covid-19 in the last 10 days?
(This question is mandatory)
Do you have/have you experienced any of the following COVID-19 symptoms in the past 10 days: fever, headache, dry cough

If you answer “YES” to any of the above, access will unfortunately not be granted to Entabeni at this time and you are required to self-isolate. Please contact the COVID-19 hotline at 0800 029 999 or by Whatsapp on 0600 123456

If you answer “NO” to all of the above, you may proceed to enter Entabeni. If you develop symptoms whilst at Entabeni please inform the Receptionist or Coordinator on duty.

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 Entabeni, guests and staff at risk. I furthermore understand and agree that by answering yes to any of the above questions, access will not be granted and I will be required to self isolate.

Screening Results

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