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Health Declaration Form

For the safety of our staff and diners, please provide only accurate information. They may be submitted to the authorities to assist contact tracing if necessary. This form is compulsory to complete before entry into our restaurants. – Platform Hospitality Group

Health Declaration Form

PERSONAL DETAILS

DINE IN DETAILS

time of arrival *
:
dining outlet *

CUSTOMER CONTACT DETAILS

Please declare if you have either/both of the following : (a) developed any symptoms of ill health such as flu, cough, sore throat, breathing difficulties, fever and loss of taste? (b) come in contact with another person who has been diagnosed with Covid-19? *
*