Sample Health Screening Form Questions
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.
Please Check One:
☐ I have provided proof of vaccination
☐ I have provided proof of a negative COVID-19 test taken within 72 hours of today
[Please note that some destinations may require vaccination as a condition to entry, in which case a negative test result is not an alternative to the vaccine.]
• 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 in close contact with someone experiencing COVID-19 symptoms or with someone diagnosed with COVID-19 in the past 14 days.
• I certify that I have not been under quarantine or isolation for COVID-19 in the past 14 days.
• I certify that I have not been diagnosed with COVID-19 in the past 14 days and that I have not tested positive for COVID-19 in the past 14 days.
Printed Name: ___________________________
* 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