COVID-19 Screening | Always Eventive

Order Number / Booking Name*

First Name*

Surname*

Contact Number*

Are you currently in isolation because you have been diagnosed with COVID-19?*

Yes
No

Have you come in contact with a person who has a confirmed case of COVID-19 within the past 14 days?*

Yes
No

Are you currently being tested for COVID-19 due to symptoms, travel or close contacts as directed by your GP or the Department of Health?*

Yes
No

Is anyone in your household being tested for COVID-19 currently?*

Yes
No

Are you experiencing any of the following*

Fever or chills
Acute respiratory infection, including coughs, sore throat, shortness of breath, runny nose
Loss of smell or taste
None

I agree I will not attend Always Eventive's premise if I have answered 'Yes' to any of the above questions, if I develop flu symptoms, suspect I have COVID-19 or have come into contact with anybody at risk of contracting COVID-19.*

I agree