Covid-19 - KDC

COVID-19 DISCLOSURE STATEMENT

Kona Diving Company takes your health as well as the health our our staff and island home seriously. Out of an abundance of caution, we are asking all of our guests to complete this form in advance of their trip to Kona.

1. Are you experiencing any of the following symptoms, or have you experienced any of these symptoms, in the last 14 days?

Fever*

Yes
No

Shortness of Breath*

Yes
No

Sore Throat & Painful Swallowing*

Yes
No

Cough*

Yes
No

Nasal congestion*

Yes
No

Chills*

Yes
No

Runny Nose*

Yes
No

Loss of sense of smell*

Yes
No

Headache*

Yes
No

Muscle aches*

Yes
No

Fatigue*

Yes
No

Loss of Appetite*

Yes
No

2. If you answered YES to any of the above, were you tested for COVID-19?

Yes
No

If YES, what was the date of your test, and status of your results (negative, positive, pending)?

TRAVEL ASSESSMENT

1. Have you traveled outside of state/province or been on a cruise in the last 30 days?*

Yes
No

If YES, what cities/countries did you travel to (please include start/end port locations for the trip)?*

2. Have you been at an airport (to meet an incoming traveler) in the last 30 days?*

Yes
No

If YES, which airport?*

3. Have you been in contact with someone who has traveled out of state/province and/or been on a cruise in the the last 30 days?*

Yes
No

If YES, where?*

SELF-DECLARATION STATEMENT:

I hereby declare that I have responded truthfully to all questions above to the best of my knowledge.

*

First Name Last Name

Signature*

Date(DD/MM/YY):*