BLAST! FILMS - COVID 19 Filming Questionnaire
(Strictly Confidential) Supervet - Series 7
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The information given below will be used by Blast! Films and the Broadcaster to assess the suitability of going ahead with the filming and will be used in a Risk Assessment.
Contributor / Attendee Details
Date of Filming:
COVID-19 Symptoms & Diagnoses
Have you been diagnosed as having COVID-19 within the last 14 days?
Have you been symptomatic, but not been diagnosed with COVID-19 in the past 14 days?
Have you come into close contact with anyone who may have been displaying symptoms of COVID-19 in last 14 days?
If you have answered yes to any of the above questions, please give further details below:
Detail your whereabouts for the previous 14 days:
Disclose any relevant pre-existing medical conditions that may mean you are more susceptible to COVID-19:
Details of any dependents and family members in the same household with special vulnerability to COVID-19:
Relationship to you:
Other Family Member
I confirm that the information above is correct, and has been given to the best of my knowledge: