Health Check

Dear visitor,

Welcome at Comprax DEMO. It is mandatory to ask a number of questions about your health.
We do store the answers for the Dutch GGD.
Retention period is 14 days.
For your convenience your mobile will remember your answers (30 days).

Check all that apply in the list below and press [Send].
At the end the page appears which you must show to an employee.
You may declare as a group where "I" represents "my group".

Health Check

I do not/do have the following symptoms

Nose cold

A runny nose

Sneezing

Sore throat

(mild) Cough

Increased temperature (up to 38°C)

Fever (over 38°C)

The following does/does not apply
NO ONE in your household has

Fever (over 38°C)

Respiratory problems

I will comply with the house rules

We are with 2 persons or less. When more than 2 persons we sit 1 household per table

First name & Last name:

Zip Code:	House number:

Phone/Mobile:

This work (Hash:6e6e75c7f3b16479c0b9ae366f9cc436) by Comprax is licensed under CC BY-NC-SA 4.0