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greg@safetynm.com
505-860-5727
Covid-19 Health Declaration
How are you feeling today?
First Name
Last Name
Email
My body temperature is not currently greater than 100°F (temperature will also be checked before class.)
I am not experiencing the symptoms: fever, cough, sore throat, chest congestion in the last 24 hours?
I am not expierincing one or more of the following gastrointestinal symptoms (nausea, vomiting, abdominal pain, diarrhea) in the last 24 hours?
I have not been evaluated by a health care professional for any of the above listed symptoms?
I haven’t been in close contact with a Covid-19 patient in the last 14 days
Initials
Date
I declare that the info I’ve provided is accurate & complete and is within 24 hours of my class held at Safety LLC.
Submit
Thanks for submitting!
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