COVID 19 Client Compliance Form

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Residential Address(Required)
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Please answer the following questions honestly. Have you had a sudden onset of the following respiratory symptoms in the last 5 days?

⦁ Fever (>38 degrees Celsius) or a history of fever or chills?
⦁ Cough (sudden onset)
⦁ Sore throat
⦁ Difficulty breathing
⦁ Loss of smell and/or taste
⦁ Body aches
⦁ Nausea, vomiting, diarrhoea
⦁ Fatigue/weakness

(Required)

AND in the last 14 days

⦁ Were you in close contact or living with any of the following:
a. A person with flu like symptoms or
b. A confirmed COVID 19 person or a person under investigation for COVID 19?

(Required)

Close contact means you were face-to-face (less than 1 meter) with the person or you were in a closed space (car, taxi or house) with the person for at least 15 minutes

⦁ Have you been admitted with severe pneumonia in the last 14 days?
⦁ Have you worked in, or attended a health care facility where COVID-19 patients are treated?
⦁ Have you been tested for COVID 19 and have you received the results of the test? If so, please provide proof by emailing RapidNetworks at support@rapidnetworks.co.za

(Required)

According to the National Institute for Communicable Diseases, the COVID19 pandemic has had a devastating impact on the immediate environment due to its fast spread via droplets from an infected person and from person to person. The virus can land on surfaces after an infected person sneezes, coughs or talks and can survive on surfaces for about nine days. As such, precautions must be taken into consideration in our interaction with others and our environments at home, work and others. As a result, RAPID NETWORKS has implemented its own internal and external policies and procedures in line with the required Guidelines and Regulations and as a Professional Sector which is able to operate while the South African State of Disaster subsists and to ensure that RAPID NETWORKS’s client risk and exposure to COVID 19 is limited.

Please note that you will be required to wash your hands in accordance with the Guidelines prior to the consultation or installation at your home or business premises. You will further be required to use the disinfectant or sanitizer which will be supplied by RAPID NETWORKS. You will also be required to wear a mask for the duration of your visit at the RAPID NETWORKS office or if RAPID NETWORKS visit your home or business premises.

In the event that an RAPID NETWORKS employee is visiting you at your home or place of business for the consultation, the RAPID NETWORKS employee will in turn be wearing the required Personal Protection Equipment and will ensure that hands are disinfected or sanitized prior to the consultation. Your temperature will be taken prior or upon you entering our office premises or RAPID NETWORKS entering your home or business premises and your temperature will be recorded.

All RAPID NETWORKS employees have had training in respect of the safety Guidelines so please feel free to ask questions prior to your consultation.

If all precautions are taken, and if the suggested 1,5meter social distancing Guideline is followed, the risk of contracting or spreading the COVID 19 virus will be much reduced.


Indemnity

After having read through the terms hereof and having made all enquiries and taking into account the risk of which I was aware, I,

Name(Required)

⦁ confirm that the COVID 19 risk mitigating measures taken by RAPID NETWORKS have been explained to me and that I have answered the above questions to the best of my knowledge and declare that the answers are true and correct.
⦁ realize that, despite all the measures taken by RAPID NETWORKS, its directors and staff I may not be 100% safe from contracting the COVID 19 virus and accept the risk, albeit small, which may exist during my visit to the RAPID NETWORKS office.
⦁ indemnify RAPID NETWORKS, its directors and all employees against any claim, loss or damage which may arise as a result of me contracting the COVID 19 virus from a source which may be unknown and will hold RAPID NETWORKS, its directors and employees harmless from any liability howsoever arising should this occur.
⦁ Confirm that I signed this indemnity of my own free will and of my own volition.


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Let us know what is on your mind

Name(Required)
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Let us know what is on your mind

Name(Required)
Email(Required)