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COVID QUESTIONNAIRE
Covid-19 Health Declaration
First Name
Last Name
Email
Phone Number:
Job Site | Rental Property Address:
My body temperature is lower than 98.6°F/ 37.5°C
I am not experiencing the symptoms: fever, cough, sore throat
I haven’t been in close contact with someone known to have Covid-19 in the last 14 days
Have you been vaccincated for COVID-19?
Yes, 1 dose
Yes, 2 doses
No
Initials
Date
I declare that the info I’ve provided is accurate & complete
Submit
