San Francisco COVID-19 Health Screening Form

Please answer the following questions before entering this location.  By Dinning at Hawker Fare SF, you are confirming that you have read and are in compliance with SF Covid-19 Health Screen Requirements in Part 1 and Part 2.

Part 1

Question 1: In the last 10 days, have you been diagnosed with COVID-19 or had a test confirming you have the virus?
Question 2: In the past 14 days, have you had “Close Contact” with someone who was diagnosed with COVID-19 or had a test confirming they have the virus while they were contagious‡? See below in regards close contact and contagiousness definations.
Question 3: Have you had one or more of these symptoms today or within the past 24 hours which is new or not explained by another condition?

What is Close Contact?

Close Contact” means you had any of the following types of contact with the person with COVID-19 while they were contagious‡:
• Lived or stayed overnight with them
• Was their intimate sex partner
• Took care of them or they took care of you
• Stayed within 6 feet of them for more than 15 minutes
• Exposed to direct contact with their body fluids or secretions (e.g., they coughed or sneezed on you) while you were not wearing a face mask, gown, and gloves


What is Contagiousness?

Contagiousness: People with COVID-19 are considered contagious starting 48 hours before their symptoms began until.

1) they haven’t had a fever for at least 24 hours,

2) their symptoms have improved, AND

3) at least 10 days have passed since their symptoms began. If the person with COVID-19 never had symptoms, then they are considered contagious starting 48 hours before their test that confirmed they have COVID-19 until 10 days after the date of that test.

Part 2 
• If you answered YES to Question 1 or Question 2:
o You MUST follow the rules mandated by the Health Officer Isolation/Quarantine Directive No 2020-03c/02c. Follow Isolation/Quarantine Steps at:
o Do not leave your home to the extent possible until the Isolation or Quarantine Steps tell you it is safe to do so!
o If you need help with essential services like food, housing, or other needs while you are isolating or quarantining, call 3-1-1.
• If you answered YES to Question 3: You may have COVID-19 and to keep others safe, you should isolate until you know whether you have COVID-19. Follow these steps:
1. Follow the instructions at:
2. GET TESTED! If you have insurance, contact your healthcare provider to get tested for COVID-19. If you do not have insurance, you can sign up for free testing at CityTestSF (
- Follow the instructions in to determine next steps depending on your test result.
Please note: Flu vaccines are critical in the fight against COVID-19 by (1) keeping workers and communities healthy and (2) reducing strain on our healthcare and testing systems that are responding to COVID-19.Those over the age of 6 months are strongly encouraged to get a flu shot. Find out how to get one at