CORONAVIRUS – HOME ENTRANCE QUESTIONNAIRE For both staff and all visitors. Please answer the questions below and follow the advice provided. Full Name* Date* DD slash MM slash YYYY Do you have a fever or high temperature (37.8C or greater)?* Yes No Please use temperature gun to check and record your readings.* Have you recently developed a new, continuous cough?* Yes No Have you recently experienced a loss of, or change in, your normal sense of taste or smell?* Yes No Does anyone in your household have the symptoms listed above* Yes No Have you recently come into contact with anyone who has been confirmed as having coronavirus (outside the care home)?* Yes No Have you been advised to isolate by the Test, Trace and Protect team?* Yes No NameThis field is for validation purposes and should be left unchanged.