Client COVID-19 Questionnaire

Client COVID-19 Questionnaire

Sky Marie Beauty
You must answer “NO” to all the questions in this questionnaire in order to receive makeup application. If you answer “YES” to any of the questions, please understand that you will not be receiving a makeup application.

If you experience any symptoms or answer “YES” to any of these questions, you must immediately contact your health care professional for recommended next steps AND notify your manager and HR. Please answer honestly.

1) Have you had any of the following symptoms in the last 24 hours? *

	Yes	No
Cough
Shortness of breath of difficulty breathing

OR at least TWO of the following symptoms in the last 24 hours: *

	Yes	No
Fever (usually 100.4 or higher)
Chills
Repeated shaking with chills
Muscle pain
Headache
Sore throat
New loss of taste or smell

If you answered “Yes” to any of these questions, You should:
- Self- quarantine for at least 10 days from the date on which you first experienced any of the above symptoms ; AND
- Wait until you have had no fever for at least 3 days (without the use of fever-reducing medication) AND
- Improved respiratory symptoms (no cough, shortness of breath)

2) In the last 14 days have you: *

	Yes	No
Been in contact with someone who was diagnosed with COVID-19?
Been in close contact with someone who had COVID-19 symptoms ?
Traveled internationally or taken a cruise

If you answered “Yes” to any part of question two, please understand that the Makeup Artist has the right to deny makeup application.

I certify to the best of my knowledge; this information is accurate.
Signature *

Clear
Name *

First Name Last Name
Date *

Month Day Year
Date
Thank you for understanding,

Sky Lepley
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Thank you for understanding,