COVID-19 Protocol | Quad Pod Studio

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Covid-19 Wellness Questionnaire

Date Entering Studio

First Name

Last Name

Please Review and Answer Each Question ON THE DAY you will be entering the studio.

My body temperature is lower than 98.6°F/ 37.5°C

I nor anyone I have been in close contact with been diagnosed with COVID-19, or been placed on quarantine for possible contact with COVID-19?

If you are experiencing any of these symptoms, please do not enter the building and contact your health provider immediately for guidance.

FEVER

LOSS OF SMELL OR TASTE

MUSCLE ACHE

SORE THROAT

COUGH

SHORTNESS OF BREATHE

CHILLS

HEADACHE

Have You Been Fully Vaccinated? If no, please note the date of your final vaccination(if applicable) If you have been fully vaccinated, please note the date of your final vaccination below.

I have reviewed and agree to abide by Quadrant Podcast Studio's COVID-19 Protocol. * By checking this box, I acknowledge I have read all of Quadrant Podcast Studio's COVID-19 Protocol and agree to abide by the guidelines.

Initials

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