Rebound Covid-19 Visitor Questionnaire

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* 1. Full Name

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* 2. Preferred Contact Information: Phone or Email of Talent, Agent or Manager

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* 3. Date Expected to arrive at the facility

Date

Date

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* 4. Are you currently under isolation or quarantine orders due to possible exposure to Covid-19, or travel requirements?

Yes

No

If yes, please state the last day of your quarantine period.

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* 5. Have you or someone you care for been diagnosed with COVID-19 in the last 14 days?

Yes

No

If yes, please specify.

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* 6. Have you had close contact (defined as within 6 feet for 10 minutes cumulatively within 24 hours) with someone diagnosed with Covid-19 within the last 14 days?

Yes

No

If yes, were you tested 3 days after exposure and did you receive a negative result?

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* 7. Have you or someone that you live with experienced any cold or flu-like symptoms in the last 14 days (fever, chills, cough, shortness of breath, difficulty of breathing, fatigue, muscle or body aches, headache, loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, diarrhea)?

Yes

No

If yes, please specify.

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* 8. By checking the "Confirm" box below, you attest that your answers for the questionnaire are truthful and accurate.

If you answered "yes" to any of the questions above, we may not be able to grant access to the facility for at least 14 days.

Confirm