• COVID-19 Questionnaire

    Due to the current COVID-19 Pandemic, we now require all workers and guests to answer this short questionnaire. This document will be considered a legal document and will be provided to the local authorities as required. It is important that the information you provide is accurate.

  • Date*
     / /
    2 digit month, 2 digit day, 4 digit year
  •  :
  • Have you completed a self assessment today?*

  • Please complete this Self Assessment. Once complete you may return to finish this assessment.

  • Have you had any symptoms of COVID-19 in the last 14 days?*
  • Have you completed the required 14 day self isolation?*

  • List of Symptoms

  • Have you ever tested positive for COVID-19?*
  • Have you completed the required 14 day self isolation?*
  • Has anyone in your household tested positive for COVID-19?*
  • Have you completed the required 14 day self isolation?*
  • Have you travelled outside of your State in the last 14 days?*
  • Have you completed the required 14 day self isolation?*

  • By signing below, I acknowledge the above to be true and will supply the above mentioned certifications.

  • Clear
  • Should be Empty: