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Croatia Bike & Boat: Islands Of The Adriatic 5
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Sample Health Screening Form

At the beginning of a tour, the guide will give guests printed versions of the health screening form to complete. Please see an example of the health screening form questions below.

SAMPLE Health Screening Form Questions

  • I certify that I am not experiencing any COVID-19-like symptoms.* According to the CDC, COVID-19 symptoms include headache, body aches, sore throat, fever or chills, muscle pain, cough, shortness of breath or difficulty breathing, fatigue, congestion or runny nose, nausea or vomiting, diarrhea, or loss of smell or taste.
  • I certify that I have not been diagnosed with COVID-19 in the past 5 days.

Printed Name: ___________________________

Signature: _______________________________

Date: _________________________

*The following conditions are not considered COVID-19-like symptoms:
• An exacerbation of a known health condition
• Seasonal allergies (with no fever)
• Conditions unrelated to the primary COVID-19 symptoms as described above
• An injury

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