{"id":12517,"date":"2021-06-29T09:06:01","date_gmt":"2021-06-29T09:06:01","guid":{"rendered":"https:\/\/archeodiving.it\/?page_id=12517"},"modified":"2021-06-29T09:06:01","modified_gmt":"2021-06-29T09:06:01","slug":"formulaire-de-declaration-de-sante-covid-19","status":"publish","type":"page","link":"https:\/\/archeodiving.it\/fr\/health-declaration-form-covid-19","title":{"rendered":"Formulaire de d\u00e9claration de sant\u00e9 \/ COVID-19"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"12517\" class=\"elementor elementor-12517\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-1bfacab elementor-section-height-min-height elementor-section-boxed elementor-section-height-default elementor-section-items-middle\" data-id=\"1bfacab\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-no\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-465ea22\" data-id=\"465ea22\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-4ebd4a2 elementor-widget__width-auto elementor-widget-tablet__width-auto elementor-view-default elementor-widget elementor-widget-icon\" data-id=\"4ebd4a2\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"icon.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-icon-wrapper\">\n\t\t\t<div class=\"elementor-icon\">\n\t\t\t<i aria-hidden=\"true\" class=\"fas fa-info-circle\"><\/i>\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-febc09e elementor-widget__width-auto elementor-widget-tablet__width-auto elementor-widget elementor-widget-heading\" data-id=\"febc09e\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">This form is mandatory for every activity made with us.<\/p>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9e780e5 elementor-button-align-stretch elementor-widget elementor-widget-form\" data-id=\"9e780e5\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;Successivo&quot;,&quot;step_previous_label&quot;:&quot;Precedente&quot;,&quot;step_type&quot;:&quot;progress_bar&quot;,&quot;button_width&quot;:&quot;100&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" id=\"modulo_covid19\" name=\"Excursions Health Declaration Form \/ COVID-19\" aria-label=\"Excursions Health Declaration Form \/ COVID-19\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"12517\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"9e780e5\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"\" \/>\n\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_c8225ed elementor-col-100\">\n\t\t\t\t\t<h1>Health Declaration Form \/ COVID-19<\/h1>\n<span>Read this statement prior to signing it. You must complete this additional medical questionnaire to enrol in a diver training program or to participate in any diving activity. If you are a minor, you must have this statement signed by your parent or guardian.<\/span><br><br>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_c6b1b96 elementor-col-100\">\n\t\t\t\t\t<!--Informazioni-->\n<span><h2>Informations<\/h2><\/span>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-date elementor-field-group elementor-column elementor-field-group-field_86c9dc0 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_86c9dc0\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDate of today\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\n\t\t<input type=\"date\" name=\"form_fields[field_86c9dc0]\" id=\"form-field-field_86c9dc0\" class=\"elementor-field elementor-size-md  elementor-field-textual elementor-date-field\" required=\"required\" pattern=\"[0-9]{4}-[0-9]{2}-[0-9]{2}\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_62510b7 elementor-col-100\">\n\t\t\t\t\t<span>The undersigned<\/span>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_385d2ed elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_385d2ed\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tName\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_385d2ed]\" id=\"form-field-field_385d2ed\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_942490e elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_942490e\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSurname\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_942490e]\" id=\"form-field-field_942490e\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-email elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-email\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tEmail\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[email]\" id=\"form-field-email\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"Email\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_e41f9c7 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_e41f9c7\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tTelephone\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_e41f9c7]\" id=\"form-field-field_e41f9c7\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"use country code if needed\" required=\"required\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Nur Nummern oder Telefon-Zeichen (#, -, *, etc) werden akzeptiert.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_6242632 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_6242632\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAddress\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_6242632]\" id=\"form-field-field_6242632\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_aa0e68b elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_aa0e68b\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHouse number\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_aa0e68b]\" id=\"form-field-field_aa0e68b\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_f423267 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_f423267\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCity\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_f423267]\" id=\"form-field-field_f423267\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_60d5d67 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_60d5d67\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCountry region\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_60d5d67]\" id=\"form-field-field_60d5d67\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_31b4274 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_31b4274\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tZIP code\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_31b4274]\" id=\"form-field-field_31b4274\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_8da28d8 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_8da28d8\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCountry\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_8da28d8]\" id=\"form-field-field_8da28d8\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_6dc6b51 elementor-col-100\">\n\t\t\t\t\t<br><br><h2>Diver Medical Questionnaire<\/h2>\n<span>The purpose of this medical questionnaire is to ensure that you are medically fit to dive. Please answer the following questions with a YES or NO. If you are not sure, answer YES. A positive response means that there may be a preexisting condition that could affect your safety while diving. If any of these items apply to you, we must request that you consult with a physician, preferably a specialist in diving medicine, prior to participating in diving activities.\n<br><br>\nWithin the 40 days immediately preceding the date of this Health Declaration Form, have you:<\/span><br><br>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_64626ab elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_64626ab\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t<br><br>TESTED POSITIVE OR PRESUMPTIVELY POSITIVE WITH COVID-19 (THE NEW CORONAVIRUS OR\u2013 SARS-COV2) OR BEEN IDENTIFIED AS A POTENTIAL CARRIER OF THE CORONAVIRUS?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_64626ab]\" id=\"form-field-field_64626ab\" class=\"elementor-field-textual elementor-size-md\">\n\t\t\t\t\t\t\t\t\t<option value=\"No\">No<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Yes\">Yes<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_bf8c387 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_bf8c387\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t<br>EXPERIENCED ANY SYMPTOMS COMMONLY ASSOCIATED WITH COVID-19 (FEVER; COUGH; FATIGUE OR MUSCLE PAIN; DIFFICULTY BREATHING; SORE THROAT; LUNG INFECTIONS; HEADACHE; LOSS OF TASTE; OR DIARRHEA)?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_bf8c387]\" id=\"form-field-field_bf8c387\" class=\"elementor-field-textual elementor-size-md\">\n\t\t\t\t\t\t\t\t\t<option value=\"No\">No<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Yes\">Yes<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_5733231 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_5733231\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t<br>BEEN IN ANY LOCATION\/SITE DECLARED AS HAZARDOUS WITH AND\/OR POTENTIALLY INFECTIVE WITH THE NEW CORONAVIRUS BY A RECOGNISED HEALTH OR REGULATORY AUTHORITY?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_5733231]\" id=\"form-field-field_5733231\" class=\"elementor-field-textual elementor-size-md\">\n\t\t\t\t\t\t\t\t\t<option value=\"No\">No<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Yes\">Yes<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_f348aa3 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_f348aa3\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t<br>BEEN IN DIRECT CONTACT WITH OR IN THE IMMEDIATE VICINITY OF ANY PERSON WHO TESTED POSITIVE WITH THE NEW CORONAVIRUS OR WHO WAS DIAGNOSED AS POSSIBLY BEING INFECTED BY THE NEW CORONAVIRUS?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_f348aa3]\" id=\"form-field-field_f348aa3\" class=\"elementor-field-textual elementor-size-md\" required=\"required\">\n\t\t\t\t\t\t\t\t\t<option value=\"No\">No<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Yes\">Yes<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_5a7ffd0 elementor-col-100\">\n\t\t\t\t\t<br><br><h2>Diver Medical Questionnaire<\/h2><br>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_502619d elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_502619d\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tI WILL, if asked, wear a protective mask at all times while participating in the diving training \/ activities arranged by <b>ARCHEO DIVING STAFF<\/b>, and will take all reasonable preventive steps that may be recommended by <b>ARCHEO DIVING STAFF<\/b>, or any relevant public authority.\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_502619d]\" id=\"form-field-field_502619d\" class=\"elementor-field-textual elementor-size-md\">\n\t\t\t\t\t\t\t\t\t<option value=\"-\">-<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Yes\">Yes<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_760f7fe elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_760f7fe\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t<br>I WILL accept and observe all instructions by <b>ARCHEO DIVING STAFF<\/b> regulations, required to help prevent the risk of transmission, including having my temperature taken prior to participating in any diving activities.\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_760f7fe]\" id=\"form-field-field_760f7fe\" class=\"elementor-field-textual elementor-size-md\">\n\t\t\t\t\t\t\t\t\t<option value=\"-\">-<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Yes\">Yes<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_809f414 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_809f414\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t<br>I ACKNOWLEDGE and ACCEPT that this declaration will be considered as my consent to <b>ARCHEO DIVING STAFF<\/b> o retain this declaration and disclose it to any relevant authority or service provider for the purposes of ensuring the safety of any third parties that may come in contact with me prior to, during, and after any diving activity.\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_809f414]\" id=\"form-field-field_809f414\" class=\"elementor-field-textual elementor-size-md\">\n\t\t\t\t\t\t\t\t\t<option value=\"-\">-<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Yes\">Yes<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_d12043c elementor-col-100\">\n\t\t\t\t\t<br><br><h2>Please Note<\/h2><br><span>COVID-19 shares many of the same symptoms as other serious viral pneumonias that require a period of convalesce before returning to full activities \u2013 a process that can take weeks or months depending on symptom severity.\n<br><br><h4>Medical Recommendation<\/h4>\n\u2022 Divers who have tested positive with COVID-19 but have remained completely asymptomatic, should wait ONE month before resuming diving.<br><br>\n\u2022 Divers who have had symptomatic COVID-19, should wait at least THREE months before applying for fit-to-dive clearance conducted by a diving medicine specialist.<br><br>\n\u2022 Divers who have been hospitalised with or because of pulmonary symptoms in relation to COVID-19, should wait at least THREE months before applying for fit-to-dive clearance conducted or coordinated by a diving medicine specialist, with complete pulmonary function testing (at least FVC, FEV1, PEF25-50-75, RV and FEV1\/FVC, and an exercise test with peripheral oxygen saturation measurement) as well as a high resolution CT scanning of the lungs.<br><br>\n\u2022 Divers who have been hospitalised with or because of cardiac problems in relation to COVID-19, should wait at least THREE months before applying for fit-to-dive clearance conducted or coordinated by a diving medicine specialist with cardiac evaluation, including echocardiography and exercise test (exercise electrocardiography).<br><br>\n<h4>General Recommendation<\/h4>\n\u2022 Divers and dive centers should observe strictly the guidelines for disinfection of diving gear (as issued by the diving federations and DAN Europe \/ Divers Alert Network).<\/span>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_34df44e elementor-col-100\">\n\t\t\t\t\t<br><h4>References<\/h4>\n<b><a style=\"color: red\" href=\"https:\/\/www.uhms.org\/images\/Position-Statements\/Return_to_Diving_Post_COVID-19_Final_NB_4-27-2020.pdf\" target=\"_blank\">Return to Diving Post COVID-19<\/a><\/b>\n<p>issued by the Undersea and Hyperbaric Medical Society (UHMS) in the USA.<\/p>\n<br>\n<b><a style=\"color: red\"href=\"http:\/\/www.sbmhs.be\/2020%200412%20Position%20of%20the%20BVOOG.pdf\" target=\"_blank\">Diving after COVID-19 pulmonary infection<\/a><\/b>\n<p>A position statement of the Belgian Society for Diving and Hyperbaric Medicine (SBMHS-BVOOG).<\/p>\n<br>\n<b><a style=\"color: red\" href=\"http:\/\/www.eubs.org\/\" target=\"_blank\">Recreational and professional diving after the Coronavirus disease (COVID-19) outbreak<\/a><\/b>\n<p>Position statement of EUBS & ECHM.<\/p>\n<br>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_0aaf2ab elementor-col-100\">\n\t\t\t\t\t<br><p style=\"color: red\">The present is a sample of a Health Declaration Form that a dive centre or dive professional may want to adopt and submit to customers and students, before taking up any diving activity with them.\nThe Form has been developed by the DAN Europe Medical Division team, based on information available as of May 2020. The epidemiological situation is constantly evolving.As a result, this document may be subject to changes and updates.<\/p><br><br>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\n\t\t\t\t\t<button class=\"elementor-button elementor-size-sm\" type=\"submit\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Send<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/form>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-347f4c0 elementor-hidden-desktop elementor-hidden-tablet elementor-hidden-phone elementor-section-full_width elementor-section-height-default elementor-section-height-default\" data-id=\"347f4c0\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-no\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-a434692\" data-id=\"a434692\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-caa3d6b elementor-widget elementor-widget-html\" data-id=\"caa3d6b\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"html.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\tHi [field id=\"field_385d2ed\"],\nthank you to have spent a bit of time to fill up our Health Declaration COVID-19 form. Your submission has been saved and will bre printed out form our staff. This form will be even stored on our Database.\n\n<!--TABELLA INFO CLIENTI-->\n\n<!--Immagine profilo-->\n\n<div class=\"covid19-form-table\" style=\"width: 900px; background-color: #f1f1f1; border-style: solid; border-radius: 20px;\">\n    \n    <div style=\"border-color: grey; text-align: center;\"><img decoding=\"async\" style=\"margin-top: 20px; margin-bottom: 20px;\" src=\"https:\/\/archeodiving.it\/wp-content\/uploads\/2019\/07\/Archeodiving_logo_outlines.svg\" width=\"135px !important\"><\/div>\n\n    <div style=\"margin-left: 10px; margin-right: 10px; font-size: 20px; font-weight: 700; border-style: solid; border-width: 1px;border-color: grey; background-color: white; text-align: center; padding: 10px; text-transform: uppercase;\">Health Declaration Form \/ COVID-19 Form<\/div>\n    \n    <div style=\"height: 50px; border-style: solid; border-width: 0px; border-color: grey; padding: 10px; text-align: center;\"><\/div>\n    \n    <div style=\"border-color: grey; text-align: center;\"><img decoding=\"async\" src=\"[field id=\"profileimg\"]\" width=\"200px\"><\/div>\n    \n    <div style=\"height: 50px; border-style: solid; border-width: 0px; border-color: grey; padding: 10px; text-align: center;\"><\/div>\n\n    <div style=\"font-size: 16px; font-weight: 700; border-color: grey; text-align: center; padding: 10px;\">General informations<\/div>\n\n<!--Info attivit\u00e0-->\n\n    <div style=\"font-size: 16px; border-color: grey; text-align: center; padding: 10px; font-weight: 600;\">Date: [field id=\"field_86c9dc0\"]<\/div>\n\n    <div style=\"font-size: 16px; border-color: grey; text-align: center; padding: 10px; font-weight: 600;\">Activity: [field id=\"field_a1448d4\"]<\/div>\n    \n    <div style=\"height: 50px; border-style: solid; border-width: 0px; border-color: grey; width: 100%; padding: 10px; text-align: center;\"><\/div>\n    \n    <div style=\"width: 100%; font-size: 16px; border-color: grey; text-align: center; padding: 10px;\">That will be made with:<br>Archeo Diving Snc<br>Via degli Oleandri 10<br>09049 Villasimius (Cagliari)<br>www.archeodiving.it<br>info@archeodiving.com<\/div>\n    \n    <div style=\"height: 50px; border-style: solid; border-width: 0px; border-color: grey; padding: 10px; text-align: center;\"><\/div>\n\n<!--Info cliente-->\n<div style=\"margin-left: 10px; margin-right: 10px;\">\n    <div style=\"font-size: 16px; border-style: solid; border-width: 1px; border-color: grey; background-color: white; padding: 10px; text-align: center;\">Name: [field id=\"field_385d2ed\"]<\/div>\n    \n    <div style=\"font-size: 16px; border-style: solid; border-width: 1px; border-color: grey; background-color: white; padding: 10px; text-align: center;\">Surname: [field id=\"field_942490e\"]<\/div>\n    \n    <div style=\"font-size: 16px; border-style: solid; border-width: 1px; border-color: grey; background-color: white; padding: 10px; text-align: center;\">E-Mail: [field id=\"email\"]<\/div>\n    \n    <div style=\"font-size: 16px; border-style: solid; border-width: 1px; border-color: grey; background-color: white; padding: 10px; text-align: center;\">Telephone: [field id=\"field_e41f9c7\"]<\/div>\n    \n    <div style=\"font-size: 13px; border-style: solid; border-width: 1px; border-color: grey; background-color: white; padding: 10px; text-align: center;\">Address:<br>[field id=\"field_6242632\"], [field id=\"field_aa0e68b\"]<br>City: [field id=\"field_f423267\"]<br>Country region: [field id=\"field_60d5d67\"]<br>ZIP code: [field id=\"field_31b4274\"]<br>Country: [field id=\"field_8da28d8\"]<\/div>\n<\/div>\n    \n<!--DICHIARAZIONE-->\n\n<div style=\"margin-left: 10px; margin-right: 10px;\">\n    <div style=\"height: 50px; border-style: solid; border-width: 0px; border-color: grey; padding: 10px; text-align: center;\"><\/div>\n    \n    <div style=\"height: 50px; font-size: 13px; font-weight: 400; border-style: solid; border-width: 1px; border-color: grey; background-color: white; padding: 10px; text-align: center;\">[field id=\"field_385d2ed\"] [field id=\"field_942490e\"]<\/div>\n    \n    <div style=\"height: 50px; font-size: 20px; font-weight: 700; border-style: solid; border-width: 1px; border-color: grey; background-color: white; padding: 10px; text-align: center;\">I DECLARE<\/div>\n    \n    <!--1-->\n    <div style=\"height: 50px; font-size: 12px; font-weight: 400; border-style: solid; border-width: 1px; border-color: grey; background-color: white; padding: 10px; text-align: center; height: auto;\">[field id=\"field_86c9dc0\"]<br><br>TESTED POSITIVE OR PRESUMPTIVELY POSITIVE WITH COVID-19 (THE NEW CORONAVIRUS OR\u2013 SARS-COV2) OR BEEN IDENTIFIED AS A POTENTIAL CARRIER OF THE CORONAVIRUS?<br><br>[field id=\"field_385d2ed\"] [field id=\"field_942490e\"] declare: <b>[field id=\"field_64626ab\"]<\/b><\/div>\n    \n    <!--2-->\n    <div style=\"height: 50px; font-size: 12px; font-weight: 400; border-style: solid; border-width: 1px; border-color: grey; background-color: white; padding: 10px; text-align: center; height: auto;\">[field id=\"field_86c9dc0\"]<br><br>EXPERIENCED ANY SYMPTOMS COMMONLY ASSOCIATED WITH COVID-19 (FEVER; COUGH; FATIGUE OR MUSCLE PAIN; DIFFICULTY BREATHING; SORE THROAT; LUNG INFECTIONS; HEADACHE; LOSS OF TASTE; OR DIARRHEA)?<br><br>[field id=\"field_385d2ed\"] [field id=\"field_942490e\"] declare: <b>[field id=\"field_bf8c387\"]<\/b><\/div>\n    \n    <!--3-->\n    <div style=\"height: 50px; font-size: 12px; font-weight: 400; border-style: solid; border-width: 1px; border-color: grey; background-color: white; padding: 10px; text-align: center; height: auto;\">[field id=\"field_86c9dc0\"]<br><br>BEEN IN ANY LOCATION\/SITE DECLARED AS HAZARDOUS WITH AND\/OR POTENTIALLY INFECTIVE WITH THE NEW CORONAVIRUS BY A RECOGNISED HEALTH OR REGULATORY AUTHORITY?<br><br>[field id=\"field_385d2ed\"] [field id=\"field_942490e\"] declare: <b>[field id=\"field_5733231\"]<\/b><\/div>\n    \n    <!--4-->\n    <div style=\"height: 50px; font-size: 12px; font-weight: 400; border-style: solid; border-width: 1px; border-color: grey; background-color: white; padding: 10px; text-align: center; height: auto;\">[field id=\"field_86c9dc0\"]<br><br>BEEN IN DIRECT CONTACT WITH OR IN THE IMMEDIATE VICINITY OF ANY PERSON WHO TESTED POSITIVE WITH THE NEW CORONAVIRUS OR WHO WAS DIAGNOSED AS POSSIBLY BEING INFECTED BY THE NEW CORONAVIRUS?<br><br>[field id=\"field_385d2ed\"] [field id=\"field_942490e\"] declare: <b>[field id=\"field_f348aa3\"]<\/b><\/div>\n    \n<!--DICHIARAZIONE AGGIUNTIVA-->\n\n<div style=\"margin-left: 10px; margin-right: 10px;\">\n    <div style=\"height: 50px; border-style: solid; border-width: 0px; border-color: grey; padding: 10px; text-align: center;\"><\/div>\n    \n    <div style=\"height: 50px; font-size: 13px; font-weight: 400; border-style: solid; border-width: 1px; border-color: grey; background-color: white; padding: 10px; text-align: center;\">[field id=\"field_385d2ed\"] [field id=\"field_942490e\"]<\/div>\n    \n    <div style=\"height: 50px; font-size: 20px; font-weight: 700; border-style: solid; border-width: 1px; border-color: grey; background-color: white; padding: 10px; text-align: center;\">I ALSO DECLARE<\/div>\n    \n    <!--11-->\n    <div style=\"height: 50px; font-size: 12px; font-weight: 400; border-style: solid; border-width: 1px; border-color: grey; background-color: white; padding: 10px; text-align: center; height: auto;\">[field id=\"field_86c9dc0\"]<br><br>I WILL, if asked, wear a protective mask at all times while participating in the diving training \/ activities arranged by <b>ARCHEO DIVING STAFF<\/b>, and will take all reasonable preventive steps that may be recommended by <b>ARCHEO DIVING STAFF<\/b>, or any relevant public authority.<br><br>[field id=\"field_385d2ed\"] [field id=\"field_942490e\"] declare: <b>[field id=\"field_502619d\"]<\/b><\/div>\n    \n    <!--12-->\n    <div style=\"height: 50px; font-size: 12px; font-weight: 400; border-style: solid; border-width: 1px; border-color: grey; background-color: white; padding: 10px; text-align: center; height: auto;\">[field id=\"field_86c9dc0\"]<br><br>I WILL accept and observe all instructions by <b>ARCHEO DIVING STAFF<\/b> regulations, required to help prevent the risk of transmission, including having my temperature taken prior to participating in any diving activities.<br><br>[field id=\"field_385d2ed\"] [field id=\"field_942490e\"] declare: <b>[field id=\"field_760f7fe\"]<\/b><\/div>\n    \n    <!--13-->\n    <div style=\"height: 50px; font-size: 12px; font-weight: 400; border-style: solid; border-width: 1px; border-color: grey; background-color: white; padding: 10px; text-align: center; height: auto;\">[field id=\"field_86c9dc0\"]<br><br>I ACKNOWLEDGE and ACCEPT that this declaration will be considered as my consent to <b>ARCHEO DIVING STAFF<\/b> o retain this declaration and disclose it to any relevant authority or service provider for the purposes of ensuring the safety of any third parties that may come in contact with me prior to, during, and after any diving activity.<br><br>[field id=\"field_385d2ed\"] [field id=\"field_942490e\"] declare: <b>[field id=\"field_809f414\"]<\/b><\/div>\n    \n    <!--14-->\n    <div style=\"height: 50px; font-size: 12px; font-weight: 400; border-style: solid; border-width: 1px; border-color: grey; background-color: white; padding: 10px; text-align: center; height: auto;\">[field id=\"field_86c9dc0\"]<br><br>14 - To have provided correct and truthful information on every choice that has been chosen and \/ or on every field that has been filled up on this form<br><br>[field id=\"field_385d2ed\"] [field id=\"field_942490e\"] declare: <b>[field id=\"field_000ffac\"]<\/b><\/div>\n<\/div>\n    \n<!--DATA e FIRMA-->\n\n<div style=\"margin-left: 10px; margin-right: 10px; margin-bottom: 35px;\">\n    <div style=\"height: 10px; border-style: solid; border-width: 0px; border-color: grey; padding: 10px; text-align: center;\"><\/div>\n    \n    <div style=\"height: auto; font-size: 13px; font-weight: 700; border-style: solid; border-width: 0px; border-color: grey; padding: 10px; text-align: center;\">Date:<br><br>...........................................................................................<\/div>\n    \n    <div style=\"height: 10px; border-style: solid; border-width: 0px; border-color: grey; padding: 10px; text-align: center;\"><\/div>\n    \n    <div style=\"height: auto; font-size: 13px; font-weight: 700; border-style: solid; border-width: 0px; border-color: grey; padding: 10px; text-align: center;\">Sign:<br><br>...........................................................................................<\/div>\n<\/div>\n    \n<\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>This form is mandatory for every activity made with us. Hi [field id=&#8221;field_385d2ed&#8221;], thank you to have spent a bit of time to fill up our Health Declaration COVID-19 form. Your submission has been saved and will bre printed out form our staff. This form will be even stored on our Database. Health Declaration Form [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":1,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"footnotes":""},"class_list":["post-12517","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/archeodiving.it\/fr\/wp-json\/wp\/v2\/pages\/12517","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/archeodiving.it\/fr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/archeodiving.it\/fr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/archeodiving.it\/fr\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/archeodiving.it\/fr\/wp-json\/wp\/v2\/comments?post=12517"}],"version-history":[{"count":0,"href":"https:\/\/archeodiving.it\/fr\/wp-json\/wp\/v2\/pages\/12517\/revisions"}],"wp:attachment":[{"href":"https:\/\/archeodiving.it\/fr\/wp-json\/wp\/v2\/media?parent=12517"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}