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.


    Are you currently waiting on the results of a COVID-19 test?

    By entering, I also acknowledge that I will observe the guest rules and policy of COHAUS which include:

    - being accompanied by the COHAUS member of whom you are a guest at all times and
    - having access to only the private bedroom of the COHAUS member you know or outdoor spaces. Access to common areas like kitchen and sitting areas will be restricted during the health pandemic.

    If you answered yes to any of the questions above, please do not enter this facility.