Attachment F - 5100_82.pdf

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FRCEASTNOTE 5100

FRCE FORM 5100/82 (FEB 2022)

PRE-TRAVEL & SITE ACCESS QUESTIONNAIRE

The safety of our employees, both Government and Contractor, remain our utmost priority at Fleet Readiness Center East (FRCE). We have implemented a screening process in order to prevent the possible spread of the Coronavirus Disease 2019 (COVID-19) and reduce potential risk of exposure. We require that all visitors to our facility complete the questionnaire below prior to travel and entry to our site. When complete, return the form to the visitor's FRCE sponsor.

Please check either "YES" or "NO" to the questions below:

YES

NO

Are you currently experiencing any of the following symptoms?

(fever, cough, sore throat and/or shortness of breath) Have you experienced any of the above symptoms in the last 14 days?

In the past 14 days, have you had close contact (within 6 feet, in a confined space, or direct contact with secretions) with anyone known to be infected with COVID-19?

Have you traveled OCONUS in the last 14 days?

Have you had close contact with or cared for someone diagnosed with COVID-19 within the last 14 days?

Have you been to any location where local the authority has ordered a "shelter-in-place"?

If you answered "yes" to ANY of the questions numbered 1 through 5, please do not travel. If you answered "yes" to only question number 6, and you are a Contractor employee, the Government Sponsor* will notify you of whether travel is allowable. If you are a Government employee, please notify your supervisor.

If you answered "no" to ALL of these questions prior to travel and upon arriving on base, you will be granted access. Please note, travelers may encounter additional on-site, self-isolate restrictions upon arrival based on changing conditions. Please contact your Government Sponsor for the latest information.

If you are a Non-FRCE government employee, contractor employee or visitor, please provide your completed questionnaire to your FRCE Sponsor* at least 24 hours in advance of travel. Please also bring a copy of this questionnaire as it may be requested upon arrival.

* A FRCE Sponsor is the federal employee (COR, TPOC, IPT Lead or any other FRCE Command Representative) who is directly responsible for the travel or visit requirement.

Additionally, the following requirements are provided for situational awareness for which the FRCE Sponsor will be responsible for ensuring compliance by their visitors:

Unvaccinated persons who are permitted access must be masked at all times unless working in physical isolation from all other persons and maintain 6 feet or greater distance from all personnel. This includes during periods of travel, lunch, and breaks following the grant of access to FRCE work spaces.

Vaccinated visitors do not have any special requirements but must wear a mask and practice social distancing as currently required for all FRCE personnel. The FRCE Sponsor will ask for a positive verification of the visitor's vaccination status in the documents provided by the visitor. If the visitor elects not to provide that information, the visitor will be subject to the same restrictions as unvaccinated visitors.

Visitors coming from OCONUS location (vaccinated or unvaccinated), may be restricted from access after arrival in the local area under a conditions based approach. The number of days will depend on the health status of the visitor's departure location.

Sponsors should contact the FRCE Response Management Center at (252) 464-5955 for guidance on self-monitoring periods. Questions on general visitor access may be directed to the Security Division at (252) 464-6991.

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