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Breakthru Beverage Group COVID-19 U.S. Visitor Screening Questionnaire

As part of Breakthru Beverage’s ongoing commitment to health and safety, all visitors to Breakthru’s facilities must answer the following health screening questions before entering the Company’s offices. Visitors are expected to provide truthful answers to these screening questions. Responses to screening questions will be maintained as confidential by the Company, subject to any legally required disclosures.

Visitor Name:

Visitor Company:

Have you had any of the following symptoms since the last time you were at work that you cannot attribute to a pre-existing health condition?

Q1 - A body temperature over 100.4 degrees Fahrenheit or a sense of having a fever?

Q2 - Chills?

Q3 - A new cough?

Q4 - A new sore throat?

Q5 - Shortness of breath or difficulty breathing?

Q6 - New muscle aches?

Q7 - A new headache?

Q8 - New loss of smell or taste?

Q9 - Nausea, vomiting or diarrhea?

Q10 - In the past 14 days, have you tested positive for COVID-19?

Q11 - Are you waiting for the results of a diagnostic COVID-19 test (a test to confirm whether you currently have the virus)?

Q12 - In the past 14 days, have you been in close contact with anyone with presumed or confirmed COVID-19? (For purposes of this question, “close contact” means that you were within 6 feet of that person for at least 10 minutes or more).

Please note that if you answer “Yes” to any of the above, you will not be permitted to enter the facilities and your meeting/visit will need to be rescheduled.

Thank you for your cooperation.