Property viewing Screening Form
Attending with Crissandra Fitzak of Howard Hanna
Name of Person viewing a Property
*
First Name
Last Name
For the purpose of viewing one or more properties today.
Required showing protocal
In the event you become symptomatic and/or test positive for COVID-19 within 48 hours of the last visit to the property, you must notify the real estate agent immediately so proper tracking and tracing can be completed.
Email
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Have you knowingly been in close or proximate contact in the past 14 days with anyone who has tested positive for COVID-19 or who has or had symptoms of COVID-19?
*
NO
Yes
Have you tested positive for COVID-19 in the past 14 days?
*
NO
Yes
Have you experienced any symptoms of COVID-19 in the past 14 days?
*
NO
Yes
Are you the Parent or Guardian of a child under the age of 18 attending the property showing with you? (If you are not attending with a minor under the age of 18 leave blank)
YES
Name of child attending with you
blanks
*
.
Have they knowingly been in close or proximate contact in the past 14 days with anyone who has tested positive for COVID-19 or who has or had symptoms of COVID-19?
*
NO
YES
Have they tested positive for COVID-19 in the past 14 days?
*
NO
Yes
Have they experienced any symptoms of COVID-19 in the past 14 days?
*
NO
Yes
Submit
Should be Empty: