Name

Address / Hotel Name

Phone Number

# in Party

Have you experienced any of the following symptoms in the past 48 hours: fever, chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, diarrhea?

Have you been in close physical contact in the last 14 days with anyone who is known to have confirmed COVID-19 or anyone who has symptoms consistent with COVID-19?

Are you isolating or quarantining because you may have been exposed to a person with COVID-19 or are worried that you may be sick with COVIID-19?

In the past 10 days, have you or a household member arrived from travel to Oahu and subject to quarantine?