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

Back	Back to top