COVID-19 Survey

COVID-19 Survey


Please fill out the survey below. It will help us greatly in making arrangments to possibly visit your facility.

Your Company (required)

Your Name (required)

Your Email (required)

Has your facility restricted service visits due to the coronavirus pandemic, either by state or local restrictions? (required)
Yes - No visits allowedYes - essential visits onlyNo - All visitors are allowed

Would you accept an updated sticker with extended due date and postpone your service visit?
YesNo

Is your facility considered an essential business?
YesNo

What qualifies your business as essential?

Do you have special policies and/or procedures to ensure social distancing guidelines and the safety of your employees and ours?
YesNo

Briefly describe or list your special policies and/or procedures."

Please confirm acceptance of the following on-site visit terms:
Checking the box confirms that as Host, you agree to:
Disinfect machine to be serviced and surroundings immediately prior to our Technician(s) arrivalProvide physical plant entrance for our Service Technician(s) that allows for proper social distancing (if possible, exterior entrances close to machine are preferred)Provide for generous social distancing between their employees and our Service Technician(s)Limit number of employees in the room where the machine is serviced as close to zero as possiblePrevent employees from entering room and coming into close proximity with Service Technician(s)If possible, arrange for access off-hours, weekends, or during shifts with minimal staffingEnsure all employees wear masks at all times in areas where our Service Technician(s) will be working or passing throughProvide contact information of the person to notify if the above items are not followed.

Has anyone in your facility tested positive for COVID-19?
YesNo

Are they actively working or quarantined away from your facility?
Immediately sheltered in placeActively working
Approximately how long ago did they test positive?