I hereby declare that

    A)I/my family member(s) in last 14 days have not interacted or lived with someone who has tested positive for COVID -19.

    B) I am not showing any signs of one or more of the following symptoms.
    Temperature > 37.3 º C (99.14 º F) or higher, cough, shortness of breath, difficulty breathing, tiredness?

    C) I will ensure to use required PPEs and maintain social distancing for prevention of spread of corona virus infection.

    I hereby declare that the above statement and information are correct to the best of my knowledge and belief.