For your safety and the safety of all the residents at this COHAUS household, we are requiring all guests
to fill in this COVID-19 form before entering. This form will need to be filled out each time you enter.
The purpose of this questionnaire is to help determine whether it is safe for you to visit this COHAUS facility. This questionnaire is not intended for the diagnosis or treatment of disease, including COVID-19.
Please carefully read and answer all the questions below.
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