COVID 19 Health Declaration

Please complete the form below and submit before your arrival at Knowsley Hall. All information for Track & Trace purposes will be kept confidential and destroyed after 21 days of your visit to us.

HEALTH DECLARATION

By entering Knowsley Hall you are agreeing to make a COVID-19 Health Declaration

Full name:
Contact Telephone Number:
Date of event you are attending:
Name of event you are attending:
Are you or any members of your household waiting for results of a recent COVID-19 test?
If you or anyone in your household has, or has had, possible or confirmed Covid-19, are you still in the self/household isolation period?
Have you had any Covid-19 related symptoms listed below in the past 14 days?
A new, continuous cough?
High temperature (37.8 or above)
Loss of, or change in your normal sense of taste and smell?
Have you travelled abroad in the past 14 days
I can confirm that if I develop COVID-19 symptoms following my visit, I will immediately inform you to enable track and trace
Date
By submitting this form you are agreeing that the above information is true and accurate

HEALTH DECLARATION

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