Covid Heath Screen | HCK9 Academy

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HCK9 ACADEMY

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Covid-19 Health Declaration

How are you feeling today? Please complete this form on the day we are scheduled to train together or meet.

First Name

Last Name

Email

My body temperature is lower than 98.6°F/ 37.5°C

I am not experiencing the symptoms: fever, cough, sore throat

I haven’t been in close contact with a Covid-19 patient in the last 14 days

Initials

Date

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

HCK9 Academy Est, 2007

hck9md@gmail.com

©2018 by HCK9 Academy

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