Nedia Group LLC. Health Screening Questionnaire

  • 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.

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  • 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.