CHAUFFEUR PRE-SCREEN

DRIVER HEALTH & SAFETY PRECAUTIONS
Reservation number *
Driver name *
Do you have a fever ? *

Yes No
Do you have shortness of breath ? *

Yes No
Do you have a cough ? *

Yes No
Are you wearing a mask ? *

Yes No
Are you wearing gloves ? *

Yes No
Was this vehicle being sanitized with disinfectant in between jobs (Lysol , Disinfectant spray) ? *

Yes No
Please upload a selfie with your mask and gloves *
Does your Vehicle have a divider take a photo *
By clicking YES and SUBMIT, you hereby confirm that this information is accurate, truthful, and you are following CDC guidelines. If you are not feeling well or do not agree to these safety precautions select NO and please inform BLS dispatch.

Yes No
Should be Empty:

DRIVER HEALTH & SAFETY PRECAUTIONS