Certification of Compliance COVID-19 Real Estate Access Questionnaire

Certification of Compliance COVID-19 Real Estate Access Questionnaire
The health and safety of our clients, customers, and real estate agents is our top priority. To reduce the risk of spreading COVID-19, Kelley Real Estate is requiring this form to be completed EVERY TIME anyone accesses a property we have listed for sale or with whom we are working as a buyer-client. This shall include all sellers, buyers, real estate agents, inspectors, appraisers, contractors, and members of the public.
Name*
First NameLast Name
Property Address (Please complete a new form for each property)*

I certify that: (Check those that apply)
I am a critical worker as defined by the State of Vermont;I have not left the state of Vermont for any reason except essential travel in the past 14 days
OR; I certify that: (Check those that apply)
I reside in a county with fewer than 400 active COVID-19 cases per million, as set forth on the Vermont Agency of Commerce and Community Development website and;I did not travel to Vermont by air or bus.I have traveled to Vermont from another state, and I traveled directly from my home in my personal vehicle, and I have completed a 14-day self-quarantine (or a 7-day self-quarantine followed by a negative test result) in that state.
Vermont Agency of Commerce and Community Development website at https://accd.vermont.gov/covid-19/restart/cross-state-travel

If you have recently traveled to Vermont to either sell or purchase a house, have you completed a quarantine in compliance with the Vermont Department of Health guidance?*
YESNO
Are you a non-Vermont resident buyer who has a property under contract for purchase with a fully-signed and accepted Purchase and Sale Contract and are you traveling to see that property?*
YESNO
I also certify:*
that I HAVE NOT had close contact within the past 14 days with a person confirmed to have COVID-19that I HAVE had close contact within the past 14 days with a person confirmed to have COVID-19
I also certify that:*
I DO NOT currently, and have not had in the past 24 hours, any of the following symptoms:I currently, or in the past 24 hours, have HAD some of the following symptoms:
- Cough
- Muscle pain
- Difficulty breathing
- Headache
- Chills
- Sore throat
- Repeated shaking with chills
- New loss of taste or smell
- Fever (feeling feverish or have a measured temperature at or above 100.4°F/38°C)
- Used a fever reducer (in the past 24 hours, have you used any medicine that reduces fevers?)
For information related to completing this form, visit:
https://accd.vermont.gov/covid-19/restart/cross-state-travel
I certify that I have answered the questions above truthfully and to the best of my knowledge. I am aware of the potential risks associated with viewing/showing the real property located at {propertyAddress40} and hold Kelley Real Estate, Inc. including its owners, employees, agents, and any affiliated companies harmless and release them from any and all claims, actions, complaints or the like related to any exposure to COVID-19.
I {name} have read and understand this entire Certificate of Compliance and make the above certifications under the pains and penalties of perjury.
Signature*
Clear
If you have any questions or concerns, please contact Robin Eatmon, Kelley Real Estate Company Safety Officer at 802-228-5333.
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