Risk Assessment Screening for COVID.PDF
PDF 439 KB Posted
- Attached to
- N656, Crossroads Food Court Renovation, and IW2012R, Upgrade Transformer Bldg. 410, MCAS Iwakuni, Japan
- Solicitation number
- W912HV-21-B-0002
About this file
This solicitation is for commercial and institutional building construction services for the renovation of the Crossroads Food Court and upgrade of Transformer Building 410 at Marine Corps Air Station Iwakuni in Japan. The scope of work includes demolishing and renovating approximately 1,486 square meters of the food court dining area and vendor kitchens, replacing portions of the interior concrete slab, storefront entryways and restrooms. Additional work consists of new wall, floor and ceiling finishes, HVAC, kitchen exhaust, plumbing, electrical and lighting systems, fire protection, telecommunications, asbestos abatement, and removal and replacement of an existing 1000kVA pad mounted transformer with a new 1500kVA transformer. The project magnitude is estimated between 1 billion and 2.5 billion Japanese yen. The solicitation was issued by the Department of the Army Corps of Engineers Engineering District Japan.
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Text version
基地内コロナウィルス感染拡大防止のための質問 Risk Assessment Screening for COVID-19 Prevention in MCAS Iwakuni
記入日 Date:
氏名 Name: 会社名 Company Name:
はい Yes
いいえ
No
1. あなた、またはあなたと同居する家族が2週間以内に以下の地域の居住者、または出身者と濃 厚接触（15分以上の接触）しましたか？https://www.mcasiwakuni.marines.mil/COVID-19- Orders_FAQ/
Have you or your household member(s) who lives with you traveled to or had prolonged close contact (greater than 15 minutes) with individuals from the following prefectures in the past 14 days: https://www.mcasiwakuni.marines.mil/COVID-19-Orders_FAQ/
2. あなた、またはあなたと同居する家族が、過去14日以内に発熱やせき、喉の痛みや息苦 しさ、原因不明の体の痛みや疲労を感じたことはありますか？ Have you or your household member(s) experienced a fever, cough, sore throat, shortness of breath, muscle aches, or suffered from fatigue in the past 14 days?
「はい」の場合、どなたが、どのような症状ですか？
If yes, who/what kind of symptom?
3. 過去１４日間のうち、あなたか、あなたの同居者が大人数の集まる場所に行ったことはあります
か？（例： スポーツ活動、その他学校活動、祭り、娯楽施設、コンサート、パーティーやそ の
ほか人が集まる類似イベントでソーシャルディスタンスの取れないないイベントへの参加）
Have you or your house hold member(s) experienced large group exposure in the past 14 days? (Ex. participation of sports events, school events, attending festivals, amusement parks, concerts, parties or similar activities that include large gatherings of people where social distancing cannot be maintained?)
4. 同居者の中に、病院、診療所、介護施設を含む医療施設で、過去14日以内にコロナ陽性 者の出た施設で働いている方がはらっしゃいますか？ Do you have any household member(s) who is under employment at a medical facility to include hospitals, clinics, or nursing homes that have reported a positive case of COVID-19 in the past 14 days?
5. 過去１４日間のうち、あなたか、あなたの同居者が以下の施設を利用したことがあります か？ バー、居酒屋、マッサージ店、タトゥーショップ、カラオケクラブ、ナイトクラブ、ラウ ンジ、パチンコ店、温泉、ホステル、利用者が成人に限定される店舗など
Have you or your household member(s) visited any of the following establishments within the last 14 days: bars, taverns, massage parlors, tattoo parlors, karaoke clubs, night clubs, lounges, pachinko parlors, onsens, hostels, or any other establishment that restricts entry to adults only?
6. あなたは以下の地域にお住まいですか？https://www.mcasiwakuni.marines.mil/COVID-19- Orders_FAQ/ Do you live within the following prefectures: https://www.mcasiwakuni.marines.mil/ COVID-19-Orders_FAQ/
「はい」の場合、どこにお住まいですか？
If yes, where do you live?
署名Signature Revised on 12/08/2020
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