KIO COVID-19 Health Survey
Hello and thank you for joining us as we reopen outdoor dining at KIO! In light of the ongoing COVID-19 pandemic, we want to ensure that everyone is taking precautions to maintain guest and staff safety. At the request of the San Francisco Department of Health, Please agree to the following conditions we have in place. We reserve the right to refuse service for health and safety reasons for any guests.


Name(s) *
Email address *
Dining Date *
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/
DD
/
YYYY
Phone number(s) *
Do you and your guests in your party agree to wear a mask at all times while not eating at the table, especially when staff members approach you? *
Do you and guests in your party agree to sanitize your hands prior to entering the restaurant? *
Do you and your guests in your party agree to use hand sanitizer once arriving at KIO before being seated? * *
Has you or someone in your party had contact with anyone with a confirmed COVID-19 diagnosis in the past 2 weeks?
Clear selection
Has you or someone in your party experienced any of the following symptoms in the past few weeks? (Check all that apply)
Has you or someone in your party taken a COVID-19 test in the last two weeks? If so, what was the result?
Clear selection
Lastly, if you or someone in your party receives a positive COVD-19 test result within 2 weeks of dining at KIO, do you agree to notify us so we may follow proper safety protocols?
Clear selection
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