Roulette COVID-19 Policies and Pre-entry Screening Questionnaire

Roulette COVID-19 Policies and Pre-entry Screening Questionnaire

Roulette requires that everyone entering the venue wear a face covering, observe social distancing guidelines, and read and respond to the following COVID-19-related screening questions. A signed version of this document must be submitted before entry into Roulette is permitted.
POLICIES TO MITIGATE THE SPREAD OF COVID-19

Roulette will operate in accordance with guidance issued by the CDC, the NYC Department of Health, state and national occupational health and safety guidance, and will utilize industry best practices for infection control in event-based environments. The health and safety of our employees, contractors, performers, and visitors is our top priority.

By clicking next, you agree to adhere to the following policies while at Roulette:

Temperature screening: Roulette will conduct temperature/health screening of all participants prior to entry. At Roulette’s sole discretion, anyone with a fever of 100.4F or over, or who does not otherwise pass the screening, will not be allowed entry.

Face coverings: Masks must be worn at all times inside Roulette except for at mutually-agreed upon times and/or in specific locations. These exceptions will be mutually agreed upon and detailed in advance of any contracted work or scheduled Event at Roulette.

Hand hygiene: You agree to wash your hands or use sanitizer immediately upon entry and after any of the following activities: using the restroom, sneezing, touching one’s face, blowing one’s nose, eating, drinking, and leaving and re-entering the venue. All persons in Roulette’s space will limit the sharing of objects, such as tools, laptops, notebooks, telephones, touchscreens, and writing utensils, as well as the touching of shared surfaces; and will be required to wear gloves when in contact with shared objects or frequently touched surfaces; or, required to perform hand hygiene before and after contact.

Physical Distancing: Everyone is asked to practice physical distancing by maintaining at least six feet of distance from one another, including while on stage. Seating and other physical layouts will be arranged to ensure appropriate distancing. Physical distancing of six feet must also be maintained around the sound booth and lighting consoles, whether or not the AV technicians are there. Markers to indicate a 6-foot perimeter will be in place.

Access: You will have access to designated areas of Roulette as previously agreed upon and/or detailed to you by Roulette staff onsite. You will abide by all signage for areas that are closed or off-limits.

Roulette Staff Instructions: Visitors, performers, rental clients, and guests agree to address questions to and follow the instructions of Roulette Staff.

Failure to Adhere to Roulette Policies: Roulette reserves the right to remove any individual from the venue who fails to adhere to any of the policies outlined above or anyone whose actions otherwise pose a health threat to others on site.

SCREENING QUESTIONS

Please answer the following screening questions 1-4:

2 - Are you caring for someone or have you knowingly come into contact with someone diagnosed with COVID-19 or with symptoms consistent with COVID-19 within the past 14 days? *

YES NO
If you answered YES to the above, entry to Roulette may not be permitted at this time. Please detail to Roulette staff before clicking next.
3 - Have you traveled internationally and/or domestically to locations with currently known travel restrictions, mandated quarantines, or border closures in the past 14 days? *

YES NO
If you answered YES to the above, entry to Roulette may not be permitted at this time. Please detail to Roulette staff before clicking next.

4 - In the past 14 days have you been tested for COVID-19? If an individual is confirmed to have COVID-19, Roulette will maintain their confidentiality as required by the Americans with Disabilities Act (ADA). *

YES NO
If YES, did you test positive or negative?

Positive Negative Awaiting Results
If you answered "Awaiting Results" please include your date of test:

Month Day Year
Date
If you answered - YES to Testing Positive for COVID-19 entry to Roulette may not be permitted at this time. Please detail to Roulette staff before clicking next.

Contact Details:
Name *

First Name Last Name
Phone Number *
EMAIL
example@example.com
Please note, Roulette will only ever use your contact information for the purposes of Contact Tracing and will only share your contact information with New York State Contact Tracers if someone at today’s event is subsequently diagnosed with Covid-19. Contact tracing is a disease control and prevention measure employed by local and state health department personnel to track known cases of Covid-19 and attempt to trace those they have come into contact with for the purposes of preventing the further spread of COVID-19.

AGREED TO AND ACCEPTED:
Signature

Clear
By signing above, I hereby confirm that I have read and understood the above questions and have answered them truthfully; and that I have read and understood Roulette’s POLICIES TO MITIGATE THE SPREAD OF COVID-19 and I agree to follow them while at Roulette. I understand that if I have not completely filled out the questionnaire, have tested positive for COVID-19 in the past 14 days, currently have any of the symptoms listed above, my temperature is higher than 100.4° F [38.0° C], I am currently caring for someone or have knowingly come into contact with someone diagnosed with COVID-19 in the past 14 days, or have traveled internationally and/or domestically to locations with currently known travel restrictions, mandated quarantines, or border closures within the past 14 days, entry to Roulette is not permitted to me at this time. I also understand that if I don’t abide by Roulette's policies, I will be asked to leave the premises immediately.
Should be Empty:

Roulette COVID-19 Policies and Pre-entry Screening Questionnaire

SCREENING QUESTIONS

Contact Details:

AGREED TO AND ACCEPTED: