Guest Name ____________________________________________________
Dates you plan to be with us_____________________________________
- Have you traveled to any of these locations in the last 14 days?
- South Korea
- New York City
- New Orleans
- Have you had any of these symptoms in the last 14 days?
- Fever greater than 100
- Difficulty breathing
- Within the last 14 days have you had contact with anyone who has shown the above systems or who was confirmed COVID-19?
- Are you currently experiencing fever over 100, difficulty breathing or cough?
- Does your job bring you regularly in contact with the public and if so, have you been working in the last 14 days?
- When in contact with those that you do not live with have you been observing social distancing and wearing a mask?
- While staying with us do you plan to be going out to public places?