Name *

First Name

Last Name

Date *

MM

DD

YYYY

Have you tested positive for COVID-19? *

Yes

No

Are you experiencing loss of taste or smell, fever, body aches, sore throat, cough, shortness of breath, or other flu-like symptoms? *

Yes

No

Have you taken your temperature today? *

This is mandatory in order to arrive on set.

Yes

No

Have you traveled to any state in the U.S. that requires you to quarantine after travel? *

Yes

No

Have you been in direct contact in the past 3 days with anyone who is suspected, presumptive positive or confirmed to have COVID-19? *

Yes

No