COVID-19 SELF-ASSESSMENT & CONDUCT AGREEMENT Question Title * 1. What is your full name? Question Title * 2. Have you recently traveled outside of the country? YES NO Question Title * 3. Have you been adhering to local, county, and federal guidelines as related to Covid-19 preventative measures for the last 14 days? YES NO Question Title * 4. Do you consent to have a non-invasive temperature check upon arrival at the studio? YES NO Question Title * 5. In the last 14 days, have you or anyone you’ve had contact with had any of the following symptoms due to coronavirus? (to the best of your knowledge) Fever or chills, Cough, Shortness of breath or difficulty breathing, Fatigue, Muscle or body aches, Headache, New loss of taste or smell, Sore throat, Congestion or runny nose, Nausea or vomiting, Diarrhea? YES NO Question Title * 6. Should you become symptomatic or test positive for Covid-19 before, during, or up to 14 days after your scheduled work, do you agree to alert Shane Salk Productions of this fact? YES NO Question Title * 7. Do you agree that all the answers to the questions above are true and correct to the best of your knowledge? AGREE DISAGREE Question Title * 8. I have reviewed and agree to adhere to the Shane Salk Productions COVID-19 Policies for recording in-studio. AGREE DISAGREE Done