Name Date And Time
Purpose: Based on the US Center Disease Control Guidelines, Reshma Haute Couture is encouraged to screen all guests for signs of respiratory illness accompanied by a fever.
Instructions: All guests entering Reshma Haute Couture must be asked the followings questions below. Reshma Haute Couture will require a new form be filled out daily. Temperature check will be made every guests enters the building regardless of day.
Do you have any of the followings respiratory symptoms?
Have you had a Temperature of 100.4 * F or greater with in the 14 days ?YesNo
Are you feeling feverish?YesNo
Are you having any chills ?YesNo
Have you been in a facility or home with confirmed Covid-19 by lab test within the last 14 days?YesNo
Have you been with (Personal/physical contact) persons with confirmed Covid-19 by lab test with in the last 14 days?YesNo