Leave this field blank Have you been fully vaccinated (full vaccination plus booster)? Yes No Have you been in close contact with a person with a confirmed case of Covid-19 within the last 5 days? Yes No Have you tested negative for Covid-19 on day 5 after this close contact? Yes No In the last 24 hours, have you had any of the following symptoms of covid? Check all that apply. Fever of 100.5 F (38 C) or above, or possible fever symptoms like alternating chills and sweating Cough Trouble breathing, shortness of breath or severe wheezing Chills or repeated shaking with chills Muscle aches Sore throat Loss of smell or taste, or a change in taste Nausea, vomiting or diarrhea Headache Fatigue Loss of appetite None of the above Compliance to Hawk Research Laboratories Protection Policy I agree to adhere to the Protection Policy. (Hawk Labs Protection Policy) Company Name Electronic Signature I agree that my typed name below will be as valid as a handwritten signature to the extent allowed by local law Send
