Covid -19 screening Health Checklist for Guests of Reshma Haute Couture

    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?

    • New or worsening cough?YesNo
    • New or worsening shortness of breath?YesNo

    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

    • if you answered NO to all questions you will be allowed entry to the building.
    • if you answered YES to any of the above questions and/or your current temperature is 100.4 or greater, you will NOT be allowed to enter Reshma Haute Couture today. If anyone have symptom then he/she can reschedule the appointment after 14 days.