HEALTH DECLARATION FORM

FOR SALON CUSTOMERS

顾客健康情况申明表

Have you been traveling for the pass 14 days? 您过去14天有旅行吗？
Have you been in close[1] contact with person suspected to have COVID-19? 您是否曾与怀疑患有COVID-19的人接触过?
Have you had any of the following symptoms over the past 14 days? Please tick if yes. 在过去的14天内，您有以下症状吗？ 如有，请打勾。

[1] Definition close contact : 近距离接触的定义:

• Health care associated exposure, including providing direct care for COVID-19 patients, working with health care workers infected with COVID-19, visiting patients or staying in the same close environment of a COVID-19 patient.

与医疗相关的接触，包括为COVID-19患者提供直接护理，与感染了COVID-19的医护人员一起工作，探视患者或与COVID-19患者保持在相同的封闭环境中。

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• Working together in close proximity or sharing the same classroom environment with a with COVID-19 patient.

与COVID-19患者共享同一个环境。

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• Traveling together with COVID-19 patient in any kind of conveyance. 与COVID-19患者一起旅行。

• Living in the same household as a COVID-19 patient. 与COVID-19患者住在同一家庭。

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