Golden Rock Hotel

Health Screening Questionnaire

Should you answer yes to any of the below questions or have any of the mentioned symptoms, we would unfortunately not be able to welcome you and you should consult a health professional.

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* 1. Within the past 14 days have you been diagnosed with COVID-19?

Yes

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* 2. Within the past 14 days have you had close contact with anyone diagnosed with COVID-19?

Yes

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* 3. Within the 14 days have you provided direct care COVID-19 patients?

Yes

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* 4. Within the past 14 days have you visited any patient having COVID-19?

Yes

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* 5. Within the past 14 days have you worked or stayed in a close environment with a COVID-19 patient?

Yes

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* 6. Within the past 14 days have you lived in the same household as a COVID-19 patient?

Yes

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* 7. Within the past 14 days have you experienced any of the following symptoms (check all reported symptoms):

Fever/Chills

Headache

Cough

Sore throat

Runny nose

Shortness of breath

Loss of taste/smell

Golden Rock Hotel

Health Screening Questionnaire

Question Title

* 1. Within the past 14 days have you been diagnosed with COVID-19?

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* 2. Within the past 14 days have you had close contact with anyone diagnosed with COVID-19?

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* 3. Within the 14 days have you provided direct care COVID-19 patients?

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* 4. Within the past 14 days have you visited any patient having COVID-19?

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* 5. Within the past 14 days have you worked or stayed in a close environment with a COVID-19 patient?

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* 6. Within the past 14 days have you lived in the same household as a COVID-19 patient?

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* 7. Within the past 14 days have you experienced any of the following symptoms (check all reported symptoms):

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* 8. Name of your reservation