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.

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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)?
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TRAVEL ASSESSMENT
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1. Have you traveled outside of state/province or been on a cruise in the last 30 days?*
- Yes
- No
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If YES, what cities/countries did you travel to (please include start/end port locations for the trip)?*
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2. Have you been at an airport (to meet an incoming traveler) in the last 30 days?*
- Yes
- No
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If YES, which airport?*
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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
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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):*
DD slash MM slash YYYY

COVID-19 DISCLOSURE STATEMENT

COVID-19 DISCLOSURE STATEMENT

TRAVEL ASSESSMENT

SELF-DECLARATION STATEMENT: