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Covid-19 Health Declaration
How are you feeling today?
First Name
Last Name
Phone
(only check if dining inside) I have provided proof of vaccine to staff prior to service
My body temperature is lower than 98.6°F/ 37.5°C and I am not experiencing the following symptoms: loss of (or change in) taste or smell, shortness of breath, unusual headache, runny nose/nasal congestion, unusual level of fatigue, unusual headache, nausea/vomitting, diarrhea, loss of appetite, feeling unwell for an unknown reason
I haven’t been in close contact with anyone with Covid-19 in the last 14 days
I haven't left the country in the past 14 days
Initials
Date
I declare that the info I’ve provided is accurate & complete
Submit
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