Fever or Chills? *

Yes

No

Difficulty Breathing or Shortness of Breath? *

Yes

No

Cough? *

Yes

No

Sore Throat or Trouble Swallowing? *

Yes

No

Runny Nose, Stuffy Nose, or Congestion? *

Yes

No

Decrease or Loss of Smell or Taste? *

Yes

No

Nausea, Vomiting, Diarrhea, Abdominal Pain? *

Yes

No

Not Feeling Well, Extreme Tiredness, Sore Muscles? *

Yes

No

Have you travelled outside of Canada in the past 14 days? *

Yes

No

In the last 14 days, have you or a member of your household tested positive for or been diagnosed by a healthcare provider with COVID-19? *

Yes

No

In the last 14 days, have you or a member of your household been instructed to self-quarantine by a health official or healthcare provider? *

Yes

No

I understand that due to the quantity of cast and crew and the characteristics of COVID 19, that I have an elevated risk of contracting the novel coronavirus simply by being on set. *

Yes

I knowingly and willingly consent to work on set during the COVID-19 pandemic. *

Yes

I’ve been provided Pyramid’s COVID guidelines and I confirm I’ve read and understand them, and am willing to adhere to them. *

Yes

I verify the information I have provided on this form is truthful and accurate. *

Yes

Name *

First Name

Last Name