COVID19 Form COVID-19 Self-Screening Form COVID-19 Self-Screening Form The safety of our customers and staff remains the LiveScan2Go’s primary concern. As the coronavirus (COVID-19) outbreak to evolve and spread globally, we are monitoring the situation closely and will periodically update our guidance on current recommendations from the CDC and the WHO. To help prevent the spread of COVID-19 and reduce the potential risk of exposure to our customers and employees, we are conducting a simple screening questionnaire. Your participation is important to help us take precautionary measures to protect you and everyone during the live scan/ notary procedure. We also respect your privacy, and this form will be held in confidence and will be kept in confidential place and destroyed after 1 year. Thank you for your time and cooperation. Date:* MM slash DD slash YYYY Contact Information Name:* Mobile Number:*Email Address:* If the answer is “yes” to one or more of the following questions, access to the service will be denied Are you showing any signs of one or more of the following symptoms?* Temperature of 100.4F° or Higher Cough Shortness of Breath Unusual Tiredness of Exhaustion None of the above Have you been exposed to someone within the last 14 Days that has tested positive for COVID-19?* Yes No Do you certify the information you have provided on this form true and correct to the best of your knowledge?Signature:*Max. file size: 100 MB.EmailThis field is for validation purposes and should be left unchanged.
