Number: NA

Appendix 1: Business Traveler Version: 1.1

Checklist _Corona Virus Period Page: 1 of 1

Location/Legal Entity: ________________________ BS/BF/SF: ____________________

1. Travel Information
Travel purpose：

Planned period:

Planned itinerary:

Planned transportation way:

Any accompany from TÜV Rheinland? (if Yes, please fill the name):
Yes No N/A
Whether travel is within the same country? Yes No N/A
2. Traveler Information
Health condition self-appraisal.
3. Travel Preparation
N95/KN95 mask or equivalent.
Yes No N/A
Thermometer.
Yes No N/A
Hand sanitizer.
Yes No N/A
Facial tissue.
Yes No N/A
Private dishware.
Yes No N/A
Other PPEs which required by the nature of the work. If Yes, please fill:
Yes No N/A
4. Training:
Have finished HSE training on Corona Virus.
Yes No N/A
5. Information of Destination Site
The client/supplier/vendor have implemented an effective Coronavirus
Prevention system (including emergency response) to control risks. If “Yes”,
Please provide relevant documentation Yes No N/A

The employee in client/supplier/vendor do not have travel history in recent one

month to the listed in WHO as COVID-19 affected country and no any Corona
Virus symptoms/case confirmed. If “Yes”, Please provide communication Yes No N/A
record. E.g., confirmation email.
Any forbidden travel notice from official website on client/supplier/vendor Yes No N/A
location
I Hereby Confirm Abovementioned Information Is Accurate and Effective
Name： Employee ID: Date：
6. Approval For Travel within Country
RO-HSE/LO HSE Signature:
Local MD (inform) Signature:
RSC/RSM/RFM/LSC/LFM Signature:
6. Approval For Travel across Country
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Appendix 1: Business Traveler Version: 1.1
Checklist _Corona Virus Period Page: 2 of 1

RSC/RSM/RFM Signature:
Local MD Signature:
RO-HSE Signature:
R-EVP Signature:
7. Notification / Approval From the local CMT of the destination Country
Has the local MD , LO or CMT informed of the travel to the destination country (Yes / No) ?
Note : Approval from the destination country is required only if you are visiting the TR location, if Not,
then only email notification to the concered MD,LO or Local CMT of the destination country is
needed.
HSE LO of the Destination TR entity Signature:
MD of the Destination TR entity Signature: