COVID QUESTIONNAIRE

COVID QUESTIONNAIRE
Thank you for taking the time to complete this form. We understand it is an extra piece of paperwork that neither you nor we would wish for, but is essential to allow us to enjoy the mountains at this time!

This form should be completed no greater than 72 hrs prior to the booking start date, and ideally the day before so as to be up-to-date. If there are problems doing this do not hesitate to contact us, but please be aware that bookings cannot proceed without this form being completed.
GENERAL

Please answer YES or NO.
A. Do you accept that your participation in the booked activity mayincrease your risk of exposure to infection with the virus relative to no-participation?

YES NO
B. Do you agree to inform your Instructor should you develop anysymptoms consistent with COVID-19 any time within 14 days of the end of theactivity? The Instructor undertakes to do the same.

YES NO
C. Please confirm that you will bring: Hand sanitiser (small bottle); Face-covering or mask; Food & drink; Suncream, midge-repellent; Small personal first aid kit (e.g. plasters,medications etc); Any technical equipment that you own yourself e.g.harnesses, belay plates, trekking poles etc

YES NO
COVID SYMPTOMS QUESTIONNAIRE

For the following questions D-I.

Now, or at any time in the last 14 days:
D. Do you have/have you had a hightemperature – this means you feel hot to touch on your chest or back (you donot need to measure your temperature)?

YES NO
E. Do you have a/have you had a new,continuous cough – this means coughing a lot for more than an hour, or 3 or morecoughing episodes in 24 hours (if you usually have a cough, it may be worsethan usual)?

YES NO
F. Do you have or have you had a loss or change to your sense ofsmell or taste – this means you've noticed you cannot smell or taste anything,or things smell or taste different to normal?

YES NO
G. Are any of your household symptomatic of COVID 19 or have any of them been?

YES NO
H. Are any of your household self-isolating or have any of them been?

YES NO
I. To the best of your knowledge have you been in close contact withanyone else who is symptomatic of COVID 19?

YES NO
If you have answered "YES" to any of the HEALTH questions D-I please give further details in the box below, otherwise leave blank.
Name

First Name Last Name
Start date of booking

Month Day Year
Date
Date this form completed

Month Day Year
Date
Signature

Clear
Should be Empty:

Now create your own Jotform - It's free! Create your own Jotform