Document.

No:

OPERATIONAL CONTROL HR/NG/037/001-00

PROCEDURE CORONA VIRUS Last Review Date:
28/02/2020

APPENDIX I
Site visit request form for Non GZI Staff

1 Name of visitor
Samuel O. Olayinka, Ph.D
2 Country of visitor Nigeria

3 Age range( e.g. 20 -25) 40 - 50

4 Country/ Location travelling from Nigeria

__________________________________________
5 Reason for visit Meeting with Cooperative Executives
___________________________________________
6 Countries/States visited in past 30 Nigeria/ Lagos
days ___________________________________________

7 Is there a Corona virus outbreak Yes

in any of the countries/ states you
have visited in the past 30 days( if
yes list) ____________________________________________
8 Have you been in contact with No
someone who has been infected
with the corona virus or any
infectious diseases in the past 30 _____________________________________________
days
9 Are you infected with the Corona No
Virus or were you previously
infected (if yes give details) _____________________________________________
10 Are you currently ill or exhibit flu No
like symptoms e.g. sore throat,
runny nose, cough, headache/
fever (if yes give details) _____________________________________________
11 Name of GZI Site to visit and Agbara/ 11am
Duration of visit _____________________________________________
12 Have you been trained on COVID Yes
19 (i.e. what to do to keep _____________________________________________
yourself and others working with
you safe, kindly attach evidence if
yes)
I confirm that the information given in this form is true, complete and accurate.

Requesters Signature Date Line Manager Signature Date

__Olayinka_______ ______13/11/2020_______ ____________________ _______________

For GZI Use

Approved/ Not Approved

_____________________________________________
Name of Approver
_____________________________________________
Signature/ Date _____________________________________________
 Document. No:

OPERATIONAL CONTROL HR/NG/037/001-00

PROCEDURE CORONA VIRUS Last Review Date:
28/02/2020