Canberra Bike Tours COVID-19 health declaration

Fields marked with an " * " are mandatory.

First Name

Last Name

Email

1. Have you tested positive for COVID-19 within the last 10 days?

COVID - What was the date you tested positive?

2. Are you waiting to be informed of the results of a recent COVID-19 test?

3. In the last 14 days have you spent any time knowingly with a person who has COVID-19?

Was this a single occurrence?

Was physical distancing maintained?

Tick all the descriptions below that best describe your exposure.

4. Do you feel unwell in any way?

Please provide more details. For example - Have you experienced this before? Will this affect your ability to ride today?

5. Fever (a temperature of 37.5˚C or higher) or chills

6. Cough

7. Sore Throat

8. Shortness of breath (difficulty breathing)

9. Fatigue or tiredness

10. Loss of Smell and/or taste?

11. Aches and Pains

12. Headache?

13. Runny or stuffy nose?

14. Diarrhoea

15. Vomiting or nausea

16. Sneezing

Please include any other details you may wish to pass onto us.

Signature. Please sign with your mouse, stylus or finger