Savoy Hotels

To be completed by each (!) guest on arrival.

This form is confidential but will be shared with local public health authorities if any other guest or staff member you have been in contact with while on our premises becomes ill with Covid-19.

Name

Surname

Age

ID/ Passport Number

Are you feeling unwell today?

YES
NO

Do you have any chronic conditions we should be aware of?

YES
NO

Do you have any other health conditions or physical impairments?

YES
NO

Did you have any Covid symptoms in the last 30 days?

YES
NO

Do you smoke

YES
NO

Do you have any history of Covid-19?

YES
NO

Do you suspect you are currently infected by Covid-19?

YES
NO

Did someone you know test positive for Covid-19?

YES
NO

If any of above questions was answered with YES, please provide more details here:

Details of any travels completed in the last 30 days:

Please provide your planned itinerary for this trip:

Prior accommodation

Following accommodation

Name and contact details of next of kin NOT travelling with you

Travel insurance declaration and proof (foreign guests only)

Enter your temperature reading (should be below 37.5)

Type in the name of the hotel staff member assisting you

I confirm that I answered all questions correctly.