Name* First Last Phone*Address* Street Address City State / Province / Region ZIP / Postal Code Time you expect to arrive at Ironworks Gym today:* : Hour Minute (military time)I have not tested positive for COVID-19 through a diagnostic test in the past 14 days.*TrueFalseI have not experienced any symptoms of COVID-19 in the past 14 days.*TrueFalseClick here for an updated list of symptoms.I have not been in close contact in the past 14 days with anyone who has tested positive for COVID-19 or who has or had symptoms of COVID-19.**Medical personnel wearing proper PPE during the care of COVID-19 positive (or suspected positive) patients are NOT considered to have been in close contact.TrueFalseI have not traveled within a state with significant community spread of COVID-19, as specified on the current Department of Health travel advisory, for longer than 24 hours within the past 14 days.*TrueFalseClick here for an updated list of the travel advisory.By clicking SUBMIT I acknowledge that if I answered “FALSE” to any of the above questions I understand that I am prohibited from entering the gym based on both public health and gym policy. Contact the local health department for guidance regarding appropriate quarantining and/or testing protocol.