COVID-19 Questionnaire
Client Safety Questionnaire
-
Within the last 14 days, have you or anyone in your household or close to you been diagnosed with COVID-19, cold or flu?
-
Are you or is anyone in your household or close to you awaiting the results of a COVID-19, cold or flu test?
-
Do you or does anyone in your household or close to you have any of these symptoms?
– cough / runny nose / sore throat
– fever / chills / muscle aches
– trouble breathing
– sudden headaches / fatigue
– loss of taste and / or smell
– nausea, vomiting, or diarrhea
-
Within the last 14 days, have you or anyone in your household traveled internationally?
-
Within the last 14 days have you or anyone in your household been on an airplane?
-
Within the last 14 days have you hosted or attended an indoor gathering of 10 people or more where guests were unmasked and their vaccination status unknown?