If you are not a staff member, please state the nature of your business.
In the past 14 days have you experienced any of the following symptoms?
In the past 14 days have you or anyone in your household been in close proximity to anyone who was experiencing any of the above symptoms, tested positive for COVID-19 or has experienced any of the above symptoms since your contact?
Have you or anyone in your household been tested for COVID-19 and are waiting to receive test results?
Please enter any pertinent information to explain a yes response to any of the above questions.
I certify that all information I have provided in this application is correct and complete.