Covid-19 Protocall
 

Health Declaration

  * Fields are mandatory
  * Please complete the fields below:
     
  Name:
  Surname:
  Email:
  Contact Number:
     
  * Do you understand that: People can catch COVID-19 from others who have the virus. *
     
  Agree
  Disagree
   
  * The disease can spread from person to person through small droplets from the nose or mouth which are spread when a person with COVID-19 coughs or exhales. *
     
  Agree
  Disagree
   
  * These droplets land on objects and surfaces around the person. *
     
  Agree
  Disagree
   
  * Other people then catch COVID-19 by touching these objects or surfaces, then touching their eyes, nose, or mouth. *
     
  Agree
  Disagree
   
  * People can also catch COVID-19 if they breathe in droplets from a person with COVID-19 who coughs out or exhales droplets. *
     
  Agree
  Disagree
   
  * This is why it is important to stay more than 2 meters away, especially from a person who is sick. *
     
  Agree
  Disagree
   
  * The COVID-19 virus has a varied incubation period during which carriers of the virus might not show symptoms yet still be highly contagious. *
     
  Agree
  Disagree
   
  * Are you suffering from any of the following symptoms *
     
  Chills
  Cough
  Sore throat
  Shortness of breath Myalgia / Body pains
  Diarrhea
  Loss of sense of taste or smell Any new skin condition on toes and hands
  No symptoms
     
  * Please note Failure to wear a mask will result in no access to the premise
     
  AGREE
   
 


 
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