The safety of our employees and clients, remain the Nedia priority. To prevent the spread of COVID-19 and reduce the potential risk of exposure to our employees and clients, we are conducting a simple screening questionnaire. Your participation is important to help us take precautionary measures to protect you and everyone in this building.
Date Format: MM slash DD slash YYYY
Please answer all the questions below
1. Within the past 10 days, have you been identified by local health authorities as a being infected or presumed infected with Coronavirus Disease 2019 (COVID-19) or directed to be under quarantine as a COVID-19 precaution?
2. In the past 14 days have you traveled internationally or returned from a state identified as having widespread community transmission of COVID-19 (other than just passing through the restricted state for less than 24 hours).
3. To the best of your knowledge, within the past 14 days, have you been in close contact with a person with confirmed a COVID-19 diagnosis or a “likely infected” diagnosis?
4. Within the past 10 days have you had a temperature of 100.4° F or higher, a new cough, new loss of taste or smell, shortness of breath or any other flu like symptoms?
By checking the box below, I knowingly and voluntarily agree to participate in Nedia Salon’s efforts to prevent COVID-19 from entering the facility, Including but not limited to checking my temperature, social distancing and wearing a mask or face covering.