"*" indicates required fields Visitor Questionnaire The safety of our employees, customers and visitors remains our top priority at SGH. As the Coronavirus (COVID-19) outbreak continues to evolve and spread globally, the company is monitoring the situation closely and will periodically update safety protocols and guidance based on the current recommendations from the Center for Disease Control and Prevention (“CDC”) and the World Health Organization (“WHO”). As an additional safety measure, SGH has updated our visitor questionnaire to include vaccine status for each visitor entering our facilities. While disclosure is voluntary for visitors, providing us with this information helps ensure a safe work environment for everyone. Please complete the below questionnaire prior to your visit:Relationship to SGH and/or our businesses (Penguin Computing, SMART Embedded, SMART Wireless, SMART Modular Technologies, and Cree LED):* Visitor Contractor, temporary worker, or consultant Employee Contact* Name* Location of Visit*Penguin Computing – Fremont, CAPremiere Logistics – Huntington Beach, CASGH – Milpitas, CASMART Modular Technologies – Newark, CASMART Embedded Computing – Tempe, ArizonaDate of Visit (Start Date):* MM slash DD slash YYYY Date of Visit (End Date):* MM slash DD slash YYYY Purpose of Visit:* Please select the option that most accurately describes your vaccination status.* Not Vaccinated – if you have not received a single dose of a COVID-19 vaccine Partially Vaccinated - if you have received a single dose of a two-dose vaccine Fully Vaccinated – if you received your second shot of a two-dose vaccine, or after you have received the one-shot of a single dose vaccine Note: While we understand that the CDC defines “fully vaccinated” as two weeks following your second dose of a two-dose regime, for your disclosure at SGH, if you have received both vaccine doses, you should mark the form as “fully vaccinated” regardless of whether the two-week period following the second shot has been fully completed.Please enter the date most relevant to your vaccination status.• If you are fully vaccinated, enter the date of your last dose • If you are partially vaccinated, enter the date of your most recent dose MM slash DD slash YYYY Proof of Vaccination I hereby consent to the provision of my vaccination card.Please upload an image of your vaccination cardMax. file size: 50 MB. Submit In order to enter any company facility, your temperature may be taken and you will be required to wear an acceptable face covering and follow social distancing protocols. Thank you for helping us maintain a safe workplace.HiddenApproval StatusAccess DeniedProof of Vaccination NeededAccess ApprovedAdditional Testing Required Δ
