COVID-19 Policy Acknowledgement & Health Attestation (Required For Facility Entry)

Brookline Interactive remains committed to providing a safe and welcoming environment. Facilitating community media work during COVID-19 necessitates that we institute protocols including requiring anyone entering to sign our COVID-19 Policy Acknowledgement & Health Attestation form before being allowed entry to Brookline Interactive. This form must be completed a minimum of two hours but no more than 24 hours prior to entry.

BIG requires all visitors to our facility to be fully vaccinated and masked while indoors. For use of BIG's equipment outside our facility we are able to make accommodations with curbside checkouts. Please fill out this form regardless of vaccination status.

Please note that all business at BIG is currently by reservation only. You may use our online system to edit, use the studio and/or reserve and checkout equipment, and you can call us if you run into any problems using the reservation system: https://www.rueshare.com/Account/Login?OrgCode=BIG.

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First & Last Name *
Phone Number *
Email Address *
I verify that I am fully vaccinated and will wear a mask while indoors at BIG.  (Fully vaccinated occurs two weeks after receiving the second dose of the two-dose vaccine (Moderna or Pfizer) or two weeks after the single-dose (J & J) vaccine.) *
If not vaccinated, or do not wish to come indoors, complete this document and indicate interested in curbside pickup.
I understand that to enter the Brookline Interactive’s facility I must be free from COVID-19 symptoms. If during your visit or subsequent to your visit, any symptoms appear, I agree to immediately notify BIG’s Executive Director or Productions Manager. *
I understand that I must always wear a CDC compliant face mask while at BIG. Masks must be clean, free of rips or tears, and worn properly (covering the nose and mouth). Gaiter-type face masks are not permitted. *
I have not had close contact with any individual diagnosed with COVID-19 in the last 14 days. *
I understand that Brookline Interactive has adopted enhanced cleaning procedures and I will comply with all cleaning and disinfecting any equipment or work area I used as requested by staff. *
Immediately upon entry, I agree to clean my hands using the hand sanitizer located at the main entrance. I will wash or sanitize my hands frequently throughout my time at BIG. *
I will immediately notify the Brookline Interactive Executive Director or Production Manager if I become aware that any person with whom I have had contact exhibits any COVID-19 symptoms, is advised to self-isolate, quarantine, or has tested positive, or is presumed positive for COVID-19. *
I understand that while at Brookline Interactive I will be in contact with staff and other members of the public who are also at risk of community exposure. I understand that no list of restrictions, guidelines, or practices will remove 100% of the risk of exposure to COVID-19 as the virus can be transmitted by persons who are asymptomatic and before some people show signs of infection. I understand that I play a crucial role in keeping everyone at Brookline Interactive safe and reducing the risk of exposure by following the practices outlined herein. *
I certify that I have read, understand, and agree to comply with the provisions listed herein. I acknowledge that failure to act in accordance with the provisions listed herein, or with any other policy or procedure outlined by Brookline Interactive in response to COVID-19 will result in disciplinary action pursuant to policy established in Brookline Interactive Rules and regulation. Please sign your initials below. *
Acknowledge with your initials.
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