YOUR DAILY
SELF ASSESSMENT
FORM

Please read our Back to Work Covid-19 Guide and complete the following registration and COVID-19 Self-Assessment, to assist us in any future contract tracing needs.

Updated June 15, 2020

  • Date Format: MM slash DD slash YYYY
  • By attending Verkspace I acknowledge I am not exhibiting any COVID-19 Symptoms (fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, new loss of taste or smell.), I have not travelled in the past 14 days, nor have I been in contact with anyone in the past 14 days who may have travelled or had a positive case of COVID-19.
  • This field is for validation purposes and should be left unchanged.