COVID-19 Visitor Wellness Attestation

COVID-19 Visitor Health Attestation

To ensure the safety of our employees and visitors, Sterne, Kessler, Goldstein & Fox requires all outside visitors to complete this Health Attestation form prior to entering the office. At this time, the wearing of masks is optional.

* required information

Full Name

Company

Confirm Email

Phone

In the last 48 hours, have you experienced any of the following symptoms that are potentially due to COVID-19?

Temperature above 99.6°F

Cough

Shortness of breath or difficulty breathing

New loss of taste or smell

Cold symptoms such as sore throat, runny nose or congestion

Nausea, vomiting or diarrhea

None of the above

Have you tested positive for COVID-19 in the last 7 days?

Yes

To your knowledge, do you currently have (or suspect that you have) an active/contagious case of COVID-19?

Yes

Upon entering Sterne Kessler's office, I agree to abide with the following requirements:

I will notify the meeting host and leave the firm's office immediately if I begin to develop any COVID-19 symptoms.

I will notify the firm if diagnosed with COVID-19 within the 7 days after visiting Sterne Kessler's office.