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Covid-19 Liability Waiver & Release

Sample coronavirus waiver form for a client to sign to provide your service business a liability release

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Covid-19 Liability Waiver

Your First Name

Name of Business

Type of Business

Email Address

Sample Health Screening Questions

Please answer these questions

1. Have you had a fever in the past 24 hours above 100 F?

Yes / No

2. Do you have, or recently had, any of the following symptoms: Cough, Fever, Headache, Loss of Smell, Loss of Taste, Muscle Aches, Shortness of Breath, Sore Throat?

Yes / No

3. Have you been in contact with anyone in the past 14 days that has symptoms or been diagnosed with COVID-19?

Yes / No

Sample COVID-19 Information

COVID-19 is a contagious virus that spreads from person to person. In addition to our regular cleaning policies and procedures that this business has in place, additional preventative measures are being followed to further reduce the spread of this novel coronavirus. However, please know that these best practices still offer no guarantee and there is a potential risk of becoming infected.

Sample Consent for Service

I understand that this business service includes physical touch and close proximity over an extended period of time. Because of this, there may be an elevated risk of disease transmission, including COVID-19. By signing this form, I acknowledge that I am aware of the risks involved from receiving service from this business at this time, I voluntarily agree to assume those risks, and I release and hold harmless this business from any and all claims related to receiving service. I give my consent to receive service from this business.

COVID-19 Liability Waiver Form

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