Initial CV-19 Service Provider Waiver
This Service Provider screener only needs to be completed by all service providers (stylist) on their first day of the return to Shear Designs II salon.

This serves as the baseline to establish that to the best of the service providers knowledge they do not have COVID-19 virus nor any symptoms related to COVID-19.
Email *
First Name *
Last Name *
1. I am aware that due to limited testing for the COVID-19, the virus has a long incubation period during which time carriers of the virus may be asymptomatic (no symptoms) and still be highly contagious. I also acknowledge that it is impossible to determine who has it. *
Required
2. I also acknowledge that I understand that anytime I am within close proximity (less than 6ft) as service provider or any other person, I could have an elevated risk of contracting the virus should it be present. *
Required
3. I confirm that none of the following COVID-19 symptoms have been present within the last 1-14 days: Fever *
Required
4. I confirm that none of the following COVID-19 symptoms have been present within the last 1-14 days: Shortness of Breath
5. I confirm that none of the following COVID-19 symptoms have been present within the last 1-14 days: Loss of taste or smell
6. I confirm that none of the following COVID-19 symptoms have been present within the last 1-14 days: Dry Cough
7. I confirm that none of the following COVID-19 symptoms have been present within the last 1-14 days: Sore Throat
8. I affirm that I have not been exposed to anyone that has been diagnosed with COVID-19 within the past 14 days inside or outside of the country I reside in. *
Required
9. I affirm that I have not traveled domestically (outside of my state) or internationally (outside of my country) within the past 14 days. *
Required
10. Do you suffer from allergies? If yes, explain what are your allergy symptoms. If no, then put "Not Applicable or N/A" below.
I agree by providing my name below, I am in essence rendering my signature in acknowledgement of the completed statements on this form and that all information is accurate as of the date of this form. *
Date *
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