COVID 19 – SELF DECLARATION
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Please complete all required fields
First Name:
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Surname:
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Date of Filming:
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Filming Location:
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Have you experienced any of the recognised symptoms of COVID-19 within the last 7 days?
High temperature or fever:
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Yes
No
A new continuous cough:
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This means coughing for longer than an hour or three or more coughing episodes in 24 hours. If you usually have a cough, it may be worse than usual.
Yes
No
Loss of sense of smell or taste:
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This means you have noticed you cannot smell or taste anything, or things smell or taste different to normal
Yes
No
Has anyone you live with had symptoms of COVID-19 in the last 10 days?
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Yes
No
Have you come into close contact with anyone who may have been displaying symptoms of COVID-19 in last 10 days?
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Yes
No
Do you consent having your temperature taken, and to the above personal information being held and processed by CPL Productions Ltd. for the purposes of managing their COVID-19 risks?
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Yes
No
I will inform a representative of the production immediately if I experience any symptoms of COVID-19.
I will inform a representative of the production immediately of any significant changes to information of the above.
Submit Declaration
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