Homeowner Questionnaire for Affiliated Engineering Laboratories (AEL) Site Inspection

Affiliated Engineering Laboratories (AEL) has been asked to perform an indoor site inspection of your premises.  To prevent the spread of the Coronavirus (COVID-19) and reduce the potential risk of exposure to our workforce we are asking that all homeowners, where an interior inspection is required, answer the following questions prior to AEL scheduling the inspection of the premises. Once the inspection is scheduled you will receive this survey again within 24 hours to identify any changes that may need to be considered.  After you have submitted the survey a representative of AEL will review this document. If a concern arises AEL will notify you to make alternative arrangements.  AEL is committed to your privacy. This information will not be shared with anyone outside of the Company and will be solely used for the purposes of rendering the decision of an inspection of your premises.  AEL reserves the right to conduct additional screening on the day of the site visit to ensure the safety of all persons.  (* Required Field)

4. Have you, or anyone within your residence, been diagnosed with Covid-19 within the last 30 days?
5. Are you, or anyone within your residence, experiencing any Covid-19 symptoms including, but not limited to, cough, shortness of breath, difficulty breathing, fever, chills, muscle pain, sore throat, new loss of taste or smell?
6. Have you, or anyone within your residence, come in contact with anyone who has been diagnosed with Covid-19?
7. Have you, or anyone within your residence, in the last 14 days, come into contact with (e.g., worked, lived with or socialized with) anyone displaying the Covid-19 symptoms?
9. If one of the states that you have listed above is Alabama, Arkansas, Arizona, Florida, North Carolina, South Carolina, Utah, Texas or Washington, have you, in the last 14 days, been quarantined without displaying any of the Covid-19 symptoms?
10. Have you, and everyone within your residence, been practicing social distancing over the last 30 days?