A questionnaire on the health and safety environment of foreign workers in the factory（100分）---备用的

:Dear visitors:You are about to visit a foodenterprise.To ensure the foodsafety and guarantee the health of the generalpublic, all the visitors areasked to fill in this health questionnaire. Wepromise, your private healthinformation would be kept confidential. Pleaseanswer the following questionshonestly.

Q1:1、Name

正确答案

Q2:2、Visitor unit:

正确答案

Q3:3、Which area below has safety risks about CO2, ammonia and steam_______.

A. Utility/Packaging/Brewing Workshop

B. Logistics area

C. Lab

Q4:4、Before entering into production area, visitor should wear PPE according to the_______.

A. Personal decision

B. Instruction sign

Q5:5、Visitors must walk on ______when walking in the brewery.

A. Walkways or Visitor channel

B. Forklift Channel

C. Vehicle Channel

Q6:6、The use of mobile phones in production area should be at least_______meters away from any machine, equipment, manipulation position, vehicle operation area.

A.1

B.2

C.3

D.4

Q7:7、Only______ persons are allowed to enter into logistics loading dispatching areas.

A. trained

B. authorized

Q8:8、In production areas, wearing jewelry is _______.

A. Forbidden

B. Allowed

Q9:9、There are explosive and flammable substances inside the brewery. Which item below is correct_____ .

A. Visitors can smoke everywhere

B. Visitors can smoke everywhere except for the explosive and flammable areas

C. Visitors can only smoke in designated areas

Q10:10、Which item below is correct______.

A. Chemical or oil is can be poured into effluent pipeline

B. The covers of manhole on storm water are painted black and ones on wastewater are painted orange

C. Wastewater and trash are forbidden to be poured into storm water pipeline

Q11:11、Classified waste collection facilities are set on site. You can put off waste into designated bins by______.

A. Size of the bin

B. Classification sign

C. Size of the waste

Q12:12、Once emergent situation happened, please move to the safe place as soon as possible. The assembly point in the brewery locates at______.

A. Eastern door or Northern door

B. Southern door or Northern door

C. Eastern door or Southern door

:----------------------------------------------------------------------------

Q13:13、Tillnow, have you had sufferedfrom the following diseases?( check a box)

A.Do not suffer from the following diseases.

B.Dysentery (pathogen carrier included)（-10.0分）

C.Viral hepatitis A (pathogencarrier included)（-10.0分）

D.Typhoid fever (pathogencarrier included)（-10.0分）

E.Viral hepatitis E (pathogencarrier included)（-10.0分）

F.Other infectiousdisease of digestive tract (pathogen carrier incl uded)（-10.0分）

G.Active tuberculosis（-10.0分）

H.Suppurative or exudative skin diseases, etc（-10.0分）

I.Obvious unhealed skin damage（-10.0分）

J.Otherdiseases may affect the food safety. Pleasespecify：（-10.0分）

Q14:14、Whatis the statusof your rehabilitation？

A.Never Had

B.has a full recovery（-10.0分）

C.under treatment（-10.0分）

D.Has not yet been treatment（-10.0分）

Q15:15、Howlong since you recovered from the above diseases？

A.Never Had

B.Within a week（-10.0分）

C.Within a month（-10.0分）

D.Within 3 months（-10.0分）

:Other requirements: You have to obey the personalprotective safety management regulations of ABI Company when you enter the workarea. One should be standardized in clean work clothes, reflective vests, hardhelmets, earplugs, protective shoes and, if necessary, wear clean protectivegloves, You have to wash hands and disinfect as required; Always put your hairinside a cap or hair net constraint.

Q16:16、DECLARATION: I declarethat the information provided by me in this formis true and correct. I willobey all kinds of food safety regulations in ABInbevconsciously.

Acceptor：________________________

Date（For example20180101）________________________

A questionnaire on the health and safety environment of foreign workers in the factory（100分）---备用的

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