SARS-CoV-2 safety graphic for professional photography studio, Gilmour Photography

COVID Screening Waiver for Photo Shoot

Due to the COVID-19 pandemic, Gilmour Photography is implementing screening waiver and measures for all individuals present on set during a shoot.

Symptoms of COVID-19 include:

  • Fever
  • Cough
  • Runny Nose
  • Sore Throat
  • Difficulty Breathing
  • NOTE: This list is not all-inclusive as COVID-19 has a wide range of unpredictable symptoms.

I agree to the following:

  • I understand the above symptoms and affirm that I, as well as all household members, do not currently have, nor have experienced the symptoms listed above or any other unusual or inexplicable health-related symptoms within the last 14 days.
  • I affirm that I, as well as all household members, have not been diagnosed with COVID-19 within the past 30 days.
  • I affirm that I, as well as all household members, have not knowingly been exposed to anyone diagnosed with COVID-19 within the past 14 days.
  • I affirm that I, as well as all household members, have not travelled internationally within the past 14 days.
  • I understand that Gilmour Photography cannot be held liable or responsible for any exposure to COVID-19 caused by misinformation on this form or the forms provided by all individuals present during the shoot.

I understand that Gilmour Photography has implemented a Health and Safety Policy with enhanced
measures to help prevent the spread of COVID-19. I confirm that this Policy has been made available to
me prior to the shoot and I understand my roles and responsibilities in complying with this Policy and
helping to implement this Policy.

By signing below, I agree to each statement above and release Gilmour Photography from any and all
liability or responsibility for exposure or harm due to COVID-19.

Signature:
Name:
Date:

Download the Screening Waiver

Related Forms

COVID-19 Assumption of Risk on Set

COVID-19 Photography Policy

DISCLAIMER

These materials were prepared by CAPIC based on current best practices and guidelines related to both health and legal safety when going back to work as a photographer. These resources do not constitute specific health, safety, or legal advice. Please do not rely on these materials without adapting them to your specific situation, including applicable guidelines and rules for where you are located.

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