Beacon Pilates COVID-19 Screening

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To be filled out by all Visitors, before entering the building.

First and last name *

Phone Number *

Which studio are you at today? *

Beacon Pilates

Pilates Studio at Allsport

Have you knowingly been in close or proximate contact in the past 14 days with anyone who has tested positive for COVID-19 or who has or had symptoms of COVID-19? *

Yes

Have you tested positive for COVID-19 in the past 14 days? *

Yes

Have you experienced any symptoms of COVID-19 in the past 14 days? *

Yes

Symptoms of Coronavirus

THE TERM “SYMPTOMATIC” INCLUDES ANYONE WHO HAS THE FOLLOWING SYMPTOMS OR COMBINATIONS OF SYMPTOMS:
Fever
Cough
Shortness Of Breath

OR AT LEAST TWO OF THE FOLLOWING SYMPTOMS:
Fever
Chills
Repeated Shaking With Chills
Muscle Pain
Headache
Sore Throat
New Loss Of Taste Or Smell

Do you have any of the symptoms listed above? *

Yes

Have you traveled outside the US within the past 14 days? *

Yes

I attest that my temperature is NOT above 99.5°

I attest that my temperature IS above 99.5°

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