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Updated January 3, 2022
Health is our top priority.  We know it is necessary to create a safe space for you and your guests while minimizing the risk to ourselves, each other and our neighbors.  In accordance with the CDC to ensure safe practices, this COVID-19 screening is part of our Site-Specific Plan safety measures for all those that step foot into Ciel.

Masks ARE REQUIRED in our common areas and restrooms. The latest guidelines for safe practices can be found here:

The most up to date CDC information can be found here:

If you are exhibiting symptoms of COVID-19 identified by the CDC or have been exposed to someone who has been diagnosed within the last 14 days, you must not enter Ciel Creative Space.
This survey will take less than 3 minutes. We appreciate your cooperation!
-Ciel Creative Space team

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Email *
First Name *
Last Name *
Today's Date *
Phone Number *
I am completing this screening on behalf of: *
I have been provided, and have accepted the terms of the Health & Hygiene Operating Procedures for COVID-19 which are on

If fully vaccinated, I agree to follow the latest CDC guidelines for safe practices which can be found here:

I have read, understood and agree to comply with the rules outlined in the Health & Hygiene Operating Procedures for COVID-19 which may include but are not limited to;

1.  Will adhere to the mandatory mask wearing in any of the building's common areas if I have NOT been vaccinated and am NOT experiencing symptoms.
2.  Submitting to a temperature check, health screening, and any required Covid-19 testing before entering the building.
3.  Will adhere to hand washing and disinfecting rules.
4.  Will follow the guidelines and notice of our on-site Compliance Assistant & Medic, when reminded of the rules.
By selecting YES, I acknowledge and accept the terms listed above: *
Please check the box(es) if your response is YES to any of the following symptoms or select NO SYMPTOMS, whether or not having received a Covid-19 vaccination: *
I confirm that I am NOT suffering from any COVID-19 symptoms and have not had any symptoms within the previous 7 days. * *
I confirm that I have NOT (as far as you are aware) been in contact with anyone with COVID-19 symptoms within the previous 14 days. * *
By selecting 'Yes' below I attest that my answers above are accurate to the best of my knowledge. * *
By selecting 'Yes' below I affirm I will notify Ciel Creative Space if there are any changes to my answers that occur after I complete this form, and before I arrive to the location. I will declare immediately any onset of symptoms or contact with anyone who has symptoms of COVID-19. I will notify or (510) 898-1586. * *
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