Covid-19 Health Declaration

This consent form provides OnSet Medics LLC with your permission to perform a COVID-19 screening procedure based on

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needed to maintain a safe environment for employees, contractors, vendors, and other essential persons with whom you may come into contact. By signing below, you are indicating that you voluntarily consent to this procedure for the detection of COVID-19.

The test being administered is a rapid diagnostic test to indicate the potential presence of COVID-19. If you decline the test, you may not be allowed to enter the production site.

This test has been approved by the FDA, however, this test alone may not be sufficient to detect or rule out the possibility that you have been exposed to or are infected with COVID-19. You should carefully monitor your own symptoms and, notwithstanding the results of any testing, you must stay home and consult with your physician if you experience symptoms of COVID-19.

You have the right to discuss the proposed testing with your physician, to learn about the purpose, potential risks and benefits of any testing. Based upon your test results, if you are denied entry to today’s production site, you should contact a physician or other medical professional for advice.

By signing below, you agree to release and waive any claim arising from your selection to receive this voluntary screening, that may arise against Onset Medics and its designated medical providers and staff members. Additionally, you agree to release and waive any claim that might arise against Onset Medics and its designated medical providers and staff members for any risks, side effects, or complications resulting from the testing. By signing below, you agree to release your test results to the production company stated above.

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