Thank you for taking the time to complete this information prior to your arrival on property and commencement of work for the 2020 Summer. Your responses are required and will assist in protecting the health and well-being of you and all visitors.

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* 1. First and Last Name

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* 2. Have you had close contact with anyone with a laboratory confirmed case of COVID19? (Note: Close contact is defined as being within 6 feet of a COVID19 patient for a prolonged period of time (5+ minutes) or having direct contact with infectious secretions of a COVID19 patient.

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* 3. In the last 6 months, have you traveled to an area at high-risk for COVID19 exposure, including China, Iran, Ireland, Italy, Malaysia, South Korea, Spain, and/or United Kingdom?

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* 4. Over the last 48 hours, please check any symptoms you have experienced:

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