Covid E Submission Questionnaire

You are important to us and in order to limit the spread of COVID-19 we would appreciate it if you could disclose the following information. All information will be processed for the purpose of COVID19 Tracking and Tracing as per Government Directive and the Protection of Personal Information Act, 2013. Please refer to the MGI Bass Gordon privacy policy at

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Employee Declaration Questions:

Have you experienced at least one of the following symptoms in the past 7 days?(Required)
Please note the following before entering the office:
  • We have a “no handshaking policy” in place.
  • We encourage you to make use of the hand sanitizers that we have made accessible.
  • Physical distancing requirements must be adhered to at all times.
I hereby declare to the best of my knowledge that the information disclosed is correct at the time of completion. I further undertake to inform my Line Manager/ Supervisor should I be diagnosed with COVID-19 or display COVID-19 symptoms.(Required)