COVID 19 WAIVER

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COVID 19 WAIVER

This waiver will remain effective until laws and mandates relevant to COVID-19 are lifted.

Email *

First Name *

Last Name *

Date Completed *

YYYY

The World Health Organization has declared the novel Coronavirus (COVID-19) a worldwide pandemic. Due to its capacity to transmit from person-to-person through respiratory droplets, the government has set recommendations, guidelines, and some prohibitions which Organization of Hope, Inc. (the "Organization") adheres to comply.

In consideration of my participation in the foregoing, and not in distress, the undersigned acknowledge and agree to the following: *

I am aware of the existence of the risk on my physical appearance to the venue and my participation to the activity of the Organization that may cause injury or illness such as, but not limited to Influenza, MRSA, or COVID-19 that may lead to paralysis or death.

I will complete daily COVID-19 Facility Screening to include having 65my temperature checked both at the beginning and ending of my work shift.

I understand that if I am not feeling well and have a temperature below 100 degrees; I will not come to work and telework from home. If my temperature is above 103 degrees; I will go to the hospital immediately.

I will notify my job in writing 64 hours before travel is executed and 48 hours after the travel ends when I have traveled to any area within the United States that reported to be highly affected by COVID-19 and will comply with any quarantine requirements .

I will notify my job in writing immediately when any member(s) of my household, or anyone I have been in contact with has been diagnosed to be infected of COVID-19 virus immediately. I will self quarantine and can not return to work without a COVID- 19 testing.

Required

Following the pronouncements above I hereby declare the following: *

I am fully and personally responsible for my own safety and actions while and during may participation and I recognize that I may be in any case be at risk of contracting COVID-19.

With full knowledge of the risks involved, I hereby release, waive, discharge the Organization, its board, officers, independent contractors, affiliates, employees, representatives, successors, and assigns from any and all liabilities, claims, demands, actions, and causes of action whatsoever, directly or indirectly arising out of or related to any loss, damage, injury, or death, that may be sustained by me related to COVID-19 while participating in any activity while in, on, or around the premises or while using the facilities that may lead to unintentional exposure or harm due to COVID-19.

I agree to indemnify, defend, and hold harmless the Organization from and against any and all costs, expenses, damages, lawsuits, and/or liabilities or claims arising whether directly or indirectly from or related to any and all claims made by or against any of the released party due to injury, loss, or death from or related to COVID-19.

Required

By signing below I acknowledge that I have read the foregoing Liability Release Waiver and understand its contents; that I am at least eighteen (18) years old and fully competent to give my consent; That I have been sufficiently informed of the risks involved and give my voluntary consent in signing it as my own free act and deed; that I give my voluntary consent in signing this Liability Release Waiver as my own free act and deed with full intention to be bound by the same, and free from any inducement or representation.

Initials *

For more information,

OOH Training Department : 443.805.8927
OOH Main Office 1.855.9. OOHHOPE (1.855.966.4467)
PW@OrganiationOfHope.org

A copy of your responses will be emailed to the address you provided.

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