COVID-19 Staff Affirmation
You must complete this form every day you come to the club. It must be done THAT DAY PRIOR TO ARRIVAL.
Email address *
Name *
Are you or anyone in your household experiencing any of the symptoms listed below? (Please consider your answers carefully and do not enter the PLEON premises if you or anyone in the household has any COVID symptoms. We need to keep each other safe.)
• Fever or experiencing chills/sweating/feeling flushed
• Sore throat
• New cough (not related to chronic condition)
• New nasal congestion or new runny nose (not related to seasonal allergies)
• New rash and/or inflammation
• Loss of taste and/or smell
• Shortness of breath
• Headaches
• Nausea, vomiting or diarrhea
I affirm to the best of my knowledge that neither I nor anyone in our household is suffering from any of the symptoms listed above and that, to the best of my knowledge, I have not been in contact with anyone diagnosed with COVID-19.
Please remember to wear a face covering at all times on PLEON grounds and docks and whenever proper distancing is not possible. Thank you for helping keep everyone safe!
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This form was created inside of Pleon Yacht Club. Report Abuse