CV-19 Service Provider Daily Waiver
This daily form is for Shear Designs II salon service providers to ensure that during the COVID-19 Pandemic, there are no symptomatic signs of the virus.
Email *
First Name *
Last Name *
Service Provider's Temperature: *
1. Have you been in contact with anyone that has been diagnosed with COVID-19 virus, and been symptomatic within the past 14 days? *
2. Have you had the following symptoms within the past 14 days? *
3. Have you had a fever? *
4. Have you had a dry cough? *
Required
5. Have you had a sore throat? *
Required
6. Have you had shortness of breath? *
Required
7. Do you have a loss of taste or smell? *
Required
8. Have you been around anyone exhibiting these symptoms within the past 14 days? *
Required
Signature (Write Below) *
Date *
MM
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DD
/
YYYY
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