Health Pre-Screen
Thank you for your assistance in mitigating the risk of exposure to COVID-19 for your fellow cast & crew members. If you have a fever or symptoms of COVID-19 that cannot be linked to another condition, please do not enter the building and contact stagemanager@vivretheatre.com
Sign in to Google to save your progress. Learn more
Name *
Have you been exposed to anyone who has tested positive for COVID-19 in the last 7 days? *
Do you have any symptoms of COVID-19, including but not limited to the following list, that cannot be attributed to another condition? Symptoms include : congestion, runny nose, cough, shortness of breath, sore throat, headache, nausea, vomiting, loss of taste or smell, fever, diarrhea, and fatigue. *
Required
To your knowledge, do you attest that you are healthy and will not expose others to COVID-19 by entering the premises ? *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Vivre Theatre. Report Abuse