4th Avenue Coffee Roasters Illovo COVID-19 Questionnaire
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First Name and Surname
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Your answer
Contact Number
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Your answer
Please Enter Your Temperature
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Your answer
Residential Area (ie. Bryanston / Illovo)
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Your answer
Have you experienced flu-like symptoms? Anything including a high fever, shortness of breath, sore throat/cough, tiredness, muscle pain, diarrhoea or any other digestive upset, loss of sense of smell or taste or any new skin conditions on toes and/or fingers.
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Yes
No
Have you tested positive for COVID-19 within the last 14 days?
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Yes
No
Have you been in contact with anyone who has tested positive for COVID-19 within the last 14 days? (Work or social)
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Yes
No
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