Fill - Free fillable JD Cooling COVID-19 Visitor Declaration Form PDF form

RegisteredAddress:JDCoolingSystemsLtd,HansaCourt,LubeckRoad,NorthLynnIndustrialEstate,King’sLynn,NorfolkPE302HN

RegistrationNo.2888433     VATRegistrationNo.745858975

VisitortoComplete



Icanconfirmthat: ifcorrect,orcommentifother:

IamaUKresident

IdonotresideinanareaaffectedbyCOVID‐19.

Ihavenottravelledtoanyofthestatedareaswherethereisa

reportedoutbreakofCOVID‐19inthelasttwoweeks.

here.

IhavenotbeenoutsideoftheUKinthelasttwoweeks. 

Ihavenotbeenindirectcontactwithanypersonwhohasbeen

testedpositivetotheCOVID‐19virus.



Iamnotcurrentlyexperiencinganysymptomsassociatedwith

theCOVID‐19virus.



Iwilladvisemyhostifanyoftheabovechangespriortomy

directvisit.



PrintedName 

Signature



Date 

Dateofproposedvisit 

Siteorofficelocation 

Host 

Ihavevisited/comefrom

(addwhereyouaretravellingfromoranycountriesyouhave

visitedinthelasttwoweeks)



Pleaseemailcompletedformtoyourhost.Theywillcompletethefollowingandsenditbacktoyouif

your‘Passport’isauthorised.



JDCoolingHosttoComplete



Icanconfirmthat: ifcorrect,orcommentifother:

Thevisitormentionedaboveisauthorisedtoattendasplanned. 

Icommittoadvisingofanychangespriortothemeetingto

enablemyvisitortomakeaninformeddecisiononiftheywish

tocontinuewiththevisit.



PrintedName 

Signature 

Date 

ContactNo. 

Pleaseemailcompletedformtoyourvisitortoconfirmthe“passport”hasbeenauthorised(pleaseCcthe

GroupH&Smanagersohecancollatetheinformation)kevinrodgers@jdcoolinggroup.com

Ifthemeetingispostponed,pleaseletyourvisitorknowingoodtime



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dd mmm yyyy

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JD Cooling COVID-19 Visitor Declaration Form

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