Hotel Health Declaration Consent Form
Full Name
Room Number
Contact Number
Date
Health Status
Have you experienced any of the following symptoms in the past 14 days? (Fever, cough, sore throat, breathing difficulty, loss of taste/smell)
Yes
No
Have you been diagnosed with any infectious disease in the last 14 days?
Yes
No
Have you had close contact with a confirmed or suspected infectious disease case in the past 14 days?
Yes
No
If you answered "Yes" to any of the above, please provide further details
Consent
I confirm that the information provided above is accurate and complete to the best of my knowledge. I consent to the processing of this information for health and safety purposes during my hotel stay.