Register form for SWB Visitors – Scheeps- en Jachtwerf L.J. Boer Sliedrecht B.V.

Register your Visit at SWB

"*" indicates required fields

Please fill out a copy of this form for each single individual. Upon arrival at our facilities check-in with information desk.

Company name*

Name / Naam*

First Name * Last Name *

Date of birth*

Phone*

Date of visit*

Arrival Time*

Reason*

Licence plate / Kenteken voertuig*

Are you currently experiencing fever- or respiratory symptoms?*

Yes

Have you been in contact with someone who has been positively diagnosed with COVID-19 within the last 14 days?*

Yes

Do you have a household member with symptoms of COVID-19?*

Yes

Entrance to our premises will be declined when tested positive or when you have ticked "yes" on one or more of the boxes above.*

I certify that the above information is correct.

Please show you ID upon arrival. Information provided is stored for no more than 3 months, and only used for COVID-19 check purposes.

Signature*

I hereby sign*

Name *

Sign date*

Date submitted *

CAPTCHA

+31 (0) 184-412303

Scheepswerf Boer
Industrieweg 18 3361 HJ Sliedrecht, Netherlands