Covid-19 Declaration Form

    Have you travelled abroad recently?
    Have you travelled in a community where there is a case of COVID-19?
    Dates of travel. (Enter N/A if not applicable)

    Have you been in contact with people being infected, suspected or diagnosed with COVID-19?
    Your relationship with the people and your last contact date with them. (Enter N/A if not applicable)

    Have you experienced or experiencing any of these? Yes / No
    Fever YesNo
    Cough YesNo
    Shortness of Breath YesNo
    Persistent Pain in the Chest YesNo
    I acknowledge that all the information given above is accurate and complete.