Initial CV-19 Safe Salon Service Provider Waiver
This Waiver only needs to be completed by all service providers on their first day of the return to the salon or Barbershop.

This serves as the baseline to establish that to the best of the service providers knowledge they do not have COVID-19 virus nor any symptoms related to COVID-19.
Sign in to Google to save your progress. Learn more
First Name *
Last Name *
My Baseline pre-visit temperature must be below 99 degree Farenheit to receive a service. Today my temperature is : *
I am aware that due to limited testing for the COVID-19, the virus has a long incubation period during which time carriers of the virus may be asymptomatic (no symptoms) and still be highly contagious. I also acknowledge that it is impossible to determine who has it . *
Required
I also acknowledge that I understand that anytime I am within close proximity (less than 6ft) of my service provider or any other person, I could have an elevated risk of contracting the virus should it be present. *
Required
I confirm that none of the following COVID-19 symptoms have been present within the last 2-14 days: Fever, Shortness of Breadth, Loss of taste or smell, Dry Cough, Runny Nose, Sore Throat, Runny Nose, Chills, Repeated Shaking with Chills, Muscle Pain or Head Ache *
Required
I affirm that I have not been exposed to anyone that has been diagnosed with COVID-19 within the past 14 days inside or outside of the country I reside in. *
Required
I affirm that I have not traveled domestically (outside of my state) or internationally (outside of my country) within the past 14 days. *
Required
I agree by providing my name below, I am in essence rendering my signature in acknowledgement of the  completed statements on this form and that all information is accurate as of the date of this form. *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms