Fill - Free fillable CORONAVIRUS (COVID-19) DECLARATION PDF form

CORONAVIRUS (COVID-19) DECLARATION

Intheinterestofprotectingthehealthandwell‐beingofourguestsandstaff,priortoyouenteringtheResort,

wearerequiredtoaskyouquestionsrelatedtoyourtravelandhealthactivities.

Name:.................................................................................... Bkg. Number: .........................................................

PhoneNumber:......................................................................................................................................................

Emailaddress:........................................................................................................................................................

Iacknowledgethat



☐

I/Wehavenotreturnedfromoverseasinthepast14days

☐

I/Weamnotrequiredtobeinself‐isolation/self‐quarantine

☐

I/WehavenotpreviouslybeendiagnosedwithCOVID‐19

☐

Tothebestofmyknowledge,I/Wehavenotbeeninclosecontactwithapersonwhohasareported

orsuspectedcaseofcoronavirus(COVID‐19)inthepast14days

☐

I/WehavenotbeeninaCOVID‐19hotspot(asdefinedbytheChiefHealthOfficer) inthepast14

days

☐

I/Wehavenothadafever,cough,sorethroat,shortnessofbreathorothercold/flu‐likesymptoms

inthelast72hoursandareotherwisewell

Ifyouansweryestoanyofthesequestionsyoumaybereferredtoalocalhealthauthority.

Pleaseprovidedetailsofalllocationsvisitedandaccommodationdetailsforthepast14days:

This information is for contact tracing purposes should it be required and  maybe shared with Police or

DepartmentofHealth officialsifrequested

LOCATION(NAMEANDADDRESS) DATESSTAYED

Pleaselistallpersons(adultsandchildren)coveredbythisdeclaration:

Person1(you):............................................................................................DateofBirth:.......................................

Person2:......................................................................................................DateofBirth:.......................................

Person3:......................................................................................................DateofBirth:.......................................

Person4:......................................................................................................DateofBirth:.......................................

I/We agree to comply with Resort rules and all Government directives, including but not limited to social

distancingmeasu

resandgoodhygienepractices.

IdeclarethattheanswersIhaveprovidedabovearetrueandaccurateformyselfandallthelistedpartieswho

areresidingwithme.

Signature:.................................................................................................................Date:.......................................

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Fillable CORONAVIRUS (COVID-19) DECLARATION

Fill Online, Printable, Fillable, Blank CORONAVIRUS (COVID-19) DECLARATION Form

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