Rimfrost Covid 19 • Olympic Subsea ASA

CORONA VIRUS (COVID-19) REGISTRATION

Welcome to Rimfrost AS.

As a visitor to our company, we kindly ask you to fill out our COVID-19 questionnaire found below.

Information given in this registration will be handled confidential and will only be used in case of tracking COVID-19.

All information will be deleted after 10 days.

Name *

Last name: *

Mobile Number: *

Company: *

1. Have you within the last 10 days travelled to countries outside Norway with widespread or sustained spread of the Novel Corona virus? *

Yes

2. Have you within the last 10 days suffering from a fever or symptoms of lower respiratory illness e.g. dry cough, difficulty breathing? *

Yes

3. Have you within the last 10 days been in contact with anyone who has recently travelled to/from "red" countries? *

Yes

4. Have you within the last 10 days been in contact with anyone who has recently been diagnosed with COVID-19 *

Yes

5. Other relevant information?

I declare that the information given in this checklist is correct. *