Participant Screening for Behind the Wheel Lessons - Over 18


 

October 20, 2020

Student’s Name:   

 

Please Answer the following questions prior to each lesson:

  • Do you have any symptoms associated with COVID - 19?    
     
  • Have you tested positive for COVID - 19?    
     
  • Have you been in close contact with anyone that has tested positive or exhibited symptoms from COVID - 19 in the last 14 days?    
     
  • Temperature at the start of the lesson:      

 

**A yes answer to any of the questions or a temperature of 100 or more will not be allowed to participate.

 

I understand the health risks associated with participating in this driving lesson due to COVID - 19 and I am willing to participate.

 

Leave this empty:

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Document name: Participant Screening for Behind the Wheel Lessons - Over 18
lock iconUnique Document ID: 45f27785b9e09d26b1d5808cd01aa945b2bab7b9
Timestamp Audit
September 28, 2020 3:16 pm EDTParticipant Screening for Behind the Wheel Lessons - Over 18 Uploaded by David Barnes - service@premierdriversed.com IP 100.16.21.104