Street Food Vendor Health Self-Assessment

Vendor Name

Stall Location

Date

1. Do you have any of the following symptoms? (Fever, cough, sore throat, shortness of breath, vomiting, diarrhea)

Yes No

2. Have you had close contact with anyone diagnosed with a contagious illness in the past 14 days?

Yes No

3. Are you experiencing any wounds or skin infections on hands/arms?

Yes No

4. Are your fingernails trimmed and clean?

Yes No

5. Additional Comments