COVID-19 HEALTH DECLARATION | Mysite

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Covid-19 Health Declaration

How are you feeling today?

First Name

Last Name

Email

Date

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 a Covid-19 patient in the last 14 days

I haven’t been outside of the USA or been in an airport in the last 14 days

I haven’t attended any events or gatherings with more than 5 people in the last 14 days

I haven’t been on a cruise ship in the last 14 days

I haven’t been in close contact with asnyone who has traveled domestically or internationally in the last 14 days

I haven't tested positive for COVID-19 in the last 21 days

Your Signature

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

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