COVID-19 Daily Screening Questionnaire

Name

First Name

Last Name

Location *

AVEX Minnesota (HQ)

AVEX North Carolina (HQ)

AVEX Las Vegas

Studio at Gremlin Theatre

Studio at North Garden Theatre

Have you had contact with anyone that you know has been diagnosed with COVID-19? Contact is defined as being within 6 feet (2 meters) for more than 15 minutes with a person, or having direct contact with infectious fluids from a person with confirmed COVID-19 (for example being coughed or sneezed on). *

yes

no

Have you had a positive-COVID test for active virus in the past 10 days? *

Yes

No

Do you have of these symptoms that you cannot attribute to another condition? *

Fever or chills Cough Shortness of breath or difficulty breathing Fatigue Muscle or body aches Headache Recent onset of loss of taste or smell Sore throat Congestion Nausea or vomiting Diarrhea

Yes

No

Terms of Entrance *

By Clicking this box you agree to abide by the safety protocols set forth by the CDC and other local state and municipal institutions related to slowing the spread of COVID-19. You also agree you understand that entering any facility of AVEX's increase your risk of exposure to the coronavirus and you further agree to release AVEX and it partners, and assigns from ANY and ALL liability related to exposure to or contraction of COVID-19. AVEX assumes no responsibility for your actions while onsite.

I Agree