Polished Nails Studio

COVID-19 Pandemic Employee/Contractor Consent Form and Release

The novel coronavirus, COVID-19, has been declared a worldwide pandemic, is extremely contagious, is believed to be spread by person-to-person contact, and may have a lengthy incubation period during which infected persons may not exhibit symptoms and still be highly contagious. 1463Nails, Inc. d/b/a Polished Nails Studio(“the Salon”) has put in place preventative measures to reduce the spread of COVID-19; however, the Salon cannot guarantee that you will not become infected with COVID-19. Further, working for or providing services to customers at the Salon may expose yo u to the virus and could increase your risk of contracting COVID-19.

Employee/Contractor Acknowledgments

I understand and acknowledge the contagious nature of COVID-19 and voluntarily assume the risks associated with COVID-19, including the risk that I may be exposed to or infected by COVID-19 as a result of working at the Salon and that such exposure or infection could result in personal injury, illness, permanent disability and/or death. I understand and acknowledge that being at the Salon may result in an elevated risk of contracting the virus. As a service provider to customers of the Salon in my capacity as an employee or independent contractor, I knowingly, voluntarily, and willingly assume such risks and accept sole responsibility for any injuries or other impacts to me. I hereby release, covenant not to sue, discharge, and hold harmless the Salon and its owners, agents and representatives of and from any and all claims and damages (including costs and expenses) of any kind arising out of or relating to COVID-19. I understand and agree that this release includes any claims based on the actions, omissions, or negligence of the Salon (including its owners, employees, independent contractors, agents, and representatives) as a result of working for or providing services at the Salon.

I knowingly and willingly consent to continue to work at the Salon and to provide services to its customers. I acknowledge and agree to follow and abide by the Salon’s guidelines and protocols implemented to prevent or minimize the spread of the virus and to protect customers, employees and other patrons or service providers at the Salon, including those implementing social distancing and other measures. I further understand and acknowledge that I will monitor my health status and that I will refrain from being present at the Salon if I should exhibit any symptoms indicative of COVID-19.

Initial each of the following:

I acknowledge being offered the opportunity to continue working at the Salon.

• Yes
• No

I confirm that I am not exhibiting any of the following symptoms of COVID-19, including fever, shortness of breath, loss of sense of smell or taste, dry cough, runny nose, or sore throat.

• Yes
• No

I confirm that I have not traveled within or outside of the United States in the past 14 days to cities, states, or countries heavily impacted by COVID-19.

• Yes
• No

To minimize or prevent the spread of the virus, I acknowledge and agree to follow and abide by the Salon’s guidelines and protocols implemented to prevent or minimize the spread of the virus, including those implementing social distancing and other measures.

• Yes
• No

I knowingly and willingly consent to working at the Salon and providing services to customers (including nail treatment and other services).

• Yes
• No

Printed Employee/Contractor Name *

Date *

SUBMIT