Model COVID-19 Certification for Property Access
Premises Address: _____________________________________________________
Date of visit: __________________________ 2020
Agent(s) for Seller/Landlord Present:
____________________________________________________________________
Potential Buyer(s)/Tenant(s) Present:
____________________________________________________________________
Agent(s) for Buyer/Tenant Present:_____________________________________________________________
Other Individual(s) Present: _______________________________
Role*: ________________________________________________
Other Individual(s) Present: _______________________________
Role*: ________________________________________________
Other Individual(s) Present: _______________________________
Role*: ________________________________________________
*i.e. - inspectors, appraisers, contractors or other transaction service providers
Seller/Landlord authorizes access to the Premises to the individual(s) who have signed below.
Each person listed above certifies that to the best of his or her knowledge neither they, nor a member of their household, nor a person with whom they are in close contact:
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Has experienced any cold or flu-like symptoms in the previous 14 days (fever, cough, sore throat, respiratory illness, difficulty breathing).
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Is currently diagnosed with COVID-19.
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Has a test pending for COVID-19.
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Is currently under quarantine due to COVID-19 concerns.
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Has had contact in the previous 14 days with someone diagnosed with COVID-19.
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Has traveled in the previous 14 days to any location designated by the Centers for Disease Control as “having widespread ongoing transmission with restrictions on entry to the United States” and/or subject to a Level 3 travel health global pandemic notice.
If access is prohibited based on the above, reasonable accommodations can be made to provide virtual access.
This certification does not constitute a legally binding contract.
ALL INDIVIDUAL(S) INTENDING TO ACCESS THE PROPERTY MUST SIGN AND PRINT YOUR NAME TO INDICATE YOUR CERTIFICATION OF ALL OF THE ABOVE:
Signature Printed Name
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________