Visitor Health Screening Questionnaire

As the coronavirus continues to spread globally, the safety and well-being of our employees, customers and
visitors is our top priority. To help prevent the spread of COVID-19 and reduce the risk of exposure, we are
screening all individuals entering our facilities, including our visitors and meeting participants. To gain entry:

• All answers to this Visitor Health Screening Questionnaire must be “no.”

• Personal protective equipment must be worn. Surgical masks provided by Stryker are mandatory for all
visitors. Gloves are required if you will be placing goods, products or documents directly in the hands of
individuals or while working at a shared workspace.
• Your temperature must be below 100.4F/38C when taken during the onsite temperature screening process.

Visitor name: Visitor phone number:

Ximena Ferná ndez Jiménez 8606-3180
Visitor company: Stryker CR Finance Center Stryker host name:

If the answer to any question below is “yes,” you will not be permitted to enter a Stryker facility or attend a
Stryker meeting/event.

In the last 48 hours, have you had any of the below symptoms?
 New cough NO
 Shortness of breath or difficulty breathing* NO
 Extreme fatigue NO
 Sore throat Body aches NO
 Vomiting or diarrhea NO
 New headaches NO
 Loss of appetite NO
 Loss of smell or taste NO
 Chills with or without repeated shaking NO
 Muscle pain NO

In the last 14 days have you:

 Traveled outside your home country, except if necessary to come to work? NO
 Been in close contact with someone who has any symptom above, or who has been diagnosed with or is
presumed to have COVID-19? NO
 Tested positive for COVID-19 via a diagnostic test? NO

If you responded “yes” to any question, immediately leave the facility and contact your healthcare
provider as needed.

By signing below, you agree to immediately contact your Stryker host to disclose any diagnosis or suspected
symptoms of COVID-19 occurring prior to and up to 14 days after your visit. You also agree that you are
voluntarily visiting this Stryker facility and Stryker will in no way be liable or otherwise assume any risk.

COVID-19 visitor health screening questionnaire | rev. 4 | 1

COVID-19 visitor health screening questionnaire | rev. 4 | 1
________________________________________ ______21/06/2021__________
Visitor signature Date

COVID-19 visitor health screening questionnaire | rev. 4 | 1