Covid Declaration

Your message has been sent

NAME

Date Form Completed

Date of Expected Return

Have you any of the following symptoms now or in the past 14 days? (Please tick box relevant to you)(required)

Have you been diagnosed with confirmed or suspected COVID-19 infection in the last 14 days?(required)

Yes

Are you a close contact person of a person who is confirmed or suspected case of COVID-19 in the past 14 days (i.e lass than 2 metres for more than 15 minutes accumulative in 1 day)?(required)

Yes

Have you been advised by a doctor to self-isolate at this time? (required)

Yes

Are you currently classified as someone who is medically vulnerable?(required)

Yes

Have you or a member of your household returned from travel abroad in the past 14 days?(required)

Yes

*** If you answered “Yes” to any of the above, please stay at home and contact the KMS Health & Safety officer on kmscovid@gmail.com***

Please sign the below with Name and Date.

I confirm that I have completed the KMS return to rehearsal training and understand my public health responsibility as a member of KMS. (Name/Date)

I confirm that if any of the above information changes, I will notify KMS Health & Safety officer as soon as possible. (Name/Date)

In signing below, I confirm that the above information is correct and that I am fit to return to rehearsal. (Name/Date)