Covid19 - Health Check | MaryJanesCamera

Covid-19 Health Declaration

How are you feeling today?

THe BC Ministry of Health has created this self assessment questionnaire to provide up-to-date guidance and recommendation for testing and follow-up for Covid19 that follow BCCDC guidance.

This declaration should be completed within 24 hrs of your photography session.

First Name

Last Name

None of the session participants are experiencing: difficulty breathing (e.g. struggling to breathe or speaking in single words), chest pain, having a very hard time waking up, feeling confused, or, loss of consciousness.

None of the session participants are experiencing the symptoms: mild to moderate shortness of breath, inability to lie down because of difficulty breathing, chronic health conditions that you are having difficulty managing because of difficulty breathing, or, cold, flu or COVID-19-like symptoms, even mild ones?

None of the session participants have travelled to any countries outside Canada (including the United States) within the last 14 days?

None of the session participants have provided care or have close contact with a person with confirmed COVID-19?

Initials

Date

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

If you answered yes to any of these questions, please contact me right away to rebook your session at later date. By signing this you are confirming that you are in good health.

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