COVID-19 Questionniare

Covid-19 Questionnaire

* indicates required field

First Name:*

Last Name:*

Email:*

Tel. number:*

ID number:*

What is the address of the property involved:

Your temperature:*

Below 37.5°C Above 37.5°C Not sure

Do you have cough?*

Yes No

Sore Throat?*

Yes No

Difficulty Breathing?*

Yes No

Loss of smell and/or loss of taste?*

Yes No

Headache?*

Yes No

Body aches?*

Yes No

Nausea, vomiting, diarrhea?*

Yes No

Fatigue / weakness?*

Yes No

Have you travelled internationally in the last 21 days?*

Yes No

Have you been in contact with anyone who has tested positive for Covid-19 in the last 14 days?*

Yes No

Are you or any immediate family member living with you waiting for results of a Covid-19 test?*

Yes No

Is there a person that will accompany you to the viewing OR is living at your home being viewed that is over the age of 60 or suffers from any comorbidities?*

Yes No

Have you worked in, or attended a health care facility where COVID patients are treated?*

Yes No

I confirm that I am aware of the risks involved and confirm that I willingly choose to proceed. I also indemnify and hold harmless the company and the Estate Agent and any other parties present during such viewing against any claim, loss or damage which may arise as a result of me contracting COVID-19. In the interest of your safety and ours, I also confirm you will adhere to the following protocols during the viewing: - Wearing of Masks. No Mask = No Viewing. - Observe Social Distancing. - Hand sanitizing before entry. - Avoid touching any areas. - Bathroom Facilities may not be used. I understand that, should I, or anyone living at or visiting the physical property viewing, be over the age of 60 or suffer from any comorbidities, the health risks involved if exposed to COVID-19 are greater, and that the health department’s recommendation is that exposure to people and work- or public places are avoided as far as possible. I agree.*