ACrew4U - COVID-19 HEALTH DECLARATION FORM - FOR CREW / TALENT / AGENCY / CLIENT ATTENDING SHOOT

As part of our commitment to provide a safe working environment for all on set during the unprecedented fast changing COVID 19 situation we need to ask you to confirm in writing by signing below, as part of your agreement with the production company engaging you, that:

You have no cause to believe that you have COVID 19 (an NHS symptom checker can be found here) or may have been exposed to COVID 19.

You have been meeting the UK Government COVID 19 guidelines and social distancing when not at work as defined here (or as per restrictions in the country where the shoot will take place)

As far as you are aware, you have not been in close contact with a confirmed case of COVID 19 or anyone who is showing symptoms consistent with COVID 19 within the last 14 days.

You have not had a cough, or a temperature of 38 degrees centigrade or above in the last 14days

If you develop a cough or a temperature of 38 degrees centigrade or above at any point before or during or within 14 days following the shoot you will immediately inform the production company engaging you.

If you are over 70 years of age or have any pre existing conditions which would put yourself at increased risk of severe illness from COVID 19 as defined by the Government here, you must inform the production.

You will notify us immediately should anything change as regards to the above confirmations

You have read, understood and agree to abide by the ACrew4U COVID-19 Shooting Guidelines

ACrew4U project reference -

Full name - *

Date of Birth - *

Job Title - *

Signature - I have read and understood the "ACrew4U - COVID-19 HEALTH DECLARATION FORM - FOR CREW / TALENT / AGENCY / CLIENT ATTENDING SHOOT" as well as the "ACrew4U - COVID-19 production & shoot guidelines (8 oct 2020)"and by signing I declare that I meet the health requirements stated and will observe the health, safety and hygiene guidelines listed above *

clear

Date of Signature - *

Please supply us with your contact details for if we need to contact you in event that crew or talent show symptoms of COVID-19 within 14 days of our shoot:

Street Address *

Address Line 2

City *

State/Province/Region *

Zip/Postal Code *

Phone Number *

Country *

Email Address *

We also need you to provide us with contact details of spouse / partner / home-dweller in the case of
emergency on set, please provide those here.

Name of resident emergency contact: *

Contact telephone number of resident emergency contact: *