1.8 1300950386 SPEC DOC COVID 19_TravelQuestionnaire.pdf

S.WFPACNOTE 6210

~l:.P O 3 2021

Strategic Weapons Facility Pacific

COVID-19 TRAVEL QUESTIONNAIRE

The below checklist will be completed for any extended travel away from personal residence, ( e.g. overnight stay). Additionally, members are required to discuss the recorded answers with supervisors for pre and post travel.

Pre-Travel:

1. Is the travel critical (i.e. help take care of loved one, pick child up from college, mission essential, etc.)?

2. Is the destination or extended stops during travel at a location with high rate of COVID cases?

3. Do you have any stops along the way to/from planned destination?

4. Duration of the trip?

5. What mode of travel will be used (i.e. plane, train, automobile, ferry)?

6. What precautions to reduce exposure to COVID virus will be employed during the travel

(limiting stops for gas and food only, using PPE at gas stations/ATMs/ groceries, other)?

7. Are you planning to be in contact with a person who has COVID-19 virus?

8. Are you attending a large gathering (>6 people)?

Post Travel:

1. Did your trip or plans discussed above alter in anyway?

2. Did you come into contact with any persons known to have the COVID-1 9 virus?

3. Did you execute your planned precautions did you take during your trip?

4. Did you stop at any high risk areas such as a hospital or medical office treating COVID-

19 patients?

5. Did you attend any large gathering of personnel (>6 people)?

Restriction of movement (ROM) and quarantine considerations:

1. Came in contact with person with COVID-19 virus.

2. Visited a high risk area such as a hospital or medical office treating COVID-19 patients.

3. Attended large gathering of (>6 people).

Enclosure (3)