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, that:
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You have no cause to believe that you have COVID-19.
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You have been meeting the Government COVID-19 guidelines and social distancing
when not at work.
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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.
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You have not travelled to, nor to your knowledge had any contact with any
individual travelling from any high COVID-19 risk countries (as deemed t by / UKF . CO . ) in
the last 14 days prior the shoot.
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You have not had a cough, or a temperature of 38 degrees centigrade or above in
the last 14 days.
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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.
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You will notify us immediately should anything change as regards to the above
confirmations.
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You have read, understood and agree to abide by the COVID-19 LGA Shooting
Guidelines.
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: ..............................
Mobile of resident emergency contact: ..............................
Print your name: ..............................
Signed: ..............................
Job Title: ..............................
Date of birth: ..............................
Date: ..............................