Covid Release Form

  • If you answer "yes" to any of the symptoms listed above, or your temperature is 100.4° F or higher, do not go into work. Immediately contact your manager to report off from work. Self-isolate at home and contact your primary physician's office for direction.
  • You should also:
  • -Isolate at home for a minimum of 7 days since symptoms first appear, AND
  • -Have 3 days without fevers (without the use of medicine) and improvement in respiratory symptoms.
  • If symptoms of such as shortness of breath are due to known, non-worsening chronic condition, mark "No".

  • 2. Within the past 48 hours, have you:
  • Had close contact with and individual who tested positive for, or was diagnosed with COVID-19?
  • If you answer "yes" to this question, please contact your manager before going to work, to further discuss. I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing. I further acknowledge that Lasting Impressions has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19 by wearing my mask at all times while on premise, and offering social distancing seating. I further acknowledge that Lasting Impressions cannot guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, staff, vendors, and/or clients. I voluntarily come to Lasting Impressions and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while in the building.