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Covid Survey
Name
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First
Last
Date
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Are you currently experiencing syptoms consistent with Covid?
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Yes
No
Have you been in contact with anyone diagnosed with Covid-19 in the last 2 weeks?
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Yes
No
Have you had contact with anyone currently undergoing testing for COVID-19 and awaiting test results?
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Yes
No
Have you recently returned from overseas?
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Yes
No
Have you recently been tested for Covid and are waiting for the results?
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Yes
No
Office Administration
Staff member to complete – Vaccine passport viewed
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Yes
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N/A
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Attendee 1
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Attendee 2
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