BYJ - Covid-19 Pre Screening Questionaire
Due to the 2020 outbreak of the novel Coronavirus, COVID-19, we are taking extra precautions at BYJ.
1. A personal prescreening health history check.
2. wearing personal protective equipment
3. The use of vigilant disinfecting practices.
4. Please wear your own mask upon arrival.

Please answer the questions below. If you answer "NO" to any question, please contact us at bikramyogajamaica@gmail.com.
Sign in to Google to save your progress. Learn more
Email *
I understand that the novel Coronavirus (COVID-19) has been declared a global pandemic by the World Health Organization (WHO). I further understand that COVID-19 is extremely contagious and may be contracted from various sources. I understand COVID-19 has a long incubation period during which carriers of the virus may not show symptoms and still be contagious *
Symptoms of COVID-19 include: *Fever, *Chills, *Dry Cough, *Sore Throat, *Body Aches, *Shortness of Breath, *Runny Nose, *Nausea, *Vomiting, *Diarrhea and *Loss of Taste or Smell. I understand these symptoms, and affirm that I, as well as all household members, do not currently have, nor have experienced the symptoms of COVID-19 within the last 30 days *
I affirm that I, and all household members, have not been diagnosed with COVID-19 within the past 30 days. *
I affirm that I, as well as all household members, have not knowingly been exposed to anyone diagnosed with COVID-19 within the last 30 days. *
I affirm that I, as well as other household members, have not traveled outside of the country, or to any city outside of our own that is or has been considered a "hotspot" for COVID-19 infections for the last 30 days. *
Please select "I agree" and electronically sign, and date before your scheduled Bikram Yoga Jamaica Class *
Name *
Today’s Date *
MM
/
DD
/
YYYY
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms