NB: Vendors are not permitted onto market area if screening has not been done or if the answer to any of the screening questions is “yes”.
Your Name (required)
Your Telephone Number (required)
Your ID Number
1.Are you suffering from fever / high temperature or temperature fluctuations? YesNo
2. Do you have a dry cough? YesNo
3. Do you have a sore throat? YesNo
4. Do you have redness of eyes? YesNo
5. Do you experience shortness of breath / difficulty in breathing? YesNo
6. Have you got unusual body aches / muscle pain? YesNo
7. Do you experience a loss of smell / taste? YesNo
8. Are you nauseous and/or do you experience unusual vomiting? YesNo
9. Have you got diarrhea? YesNo
10. Do you suffer from fatigue / physical weakness / tiredness? YesNo
1. Have you been exposed to someone diagnosed with Covid-19 or had recent contact with someone who is self-isolating whilst waiting for a Covid-19 test result? YesNo
2. Have you been in quarantine / self-isolation for the past 14 days? YesNo
I hereby attest that the information provided above is a true reflection of my screening results.
