COVID-19 Questionnaire and Declaration - Siracusa Boutique Apartments
Dear guest, following the Italian government's guidelines on safeguarding against COVID-19, we kindly ask you to fill in this questionnaire. Compliance with the safety measures required by the Italian government is mandatory in order to be hosted in our holiday rentals.
Date of Birth
Date Format: MM slash DD slash YYYY
I hereby declare that
1) In the past 14 days, I have not resided in one of the countries for which fiduciary isolation is required upon arrival in Italy;
2) In the past 14 days, I did not experience any of the following symptoms: Fever > 37.5° C (>99.5° F); Breathing difficulties; Persistent cough; Changes in taste and / or smell;
3) In the past 14 days, I did not have any contact with subjects, including family members, affected by COVID-19;
4) I have never been affected by COVID-19 and I never tested positive without adequate clinical / laboratory follow up analysis;
5) I have a medical certificate to prove my healing from COVID-19 (only applicable in case of a positive answer to point 4.)
Travel documentation for extra-EU travelers: Please upload here your flight ticket to confirm the date in which you have entered the Shengen area and/or to confirm which country you have resided in during the last 14 days.
Drop files here or
Before arriving in Sicily:
Download the "Sicilia Sicura" application and register on the website.
Download the "Immuni" application and install it.
When around Siracusa and Sicily:
Maintain at least 1-meter distance at all times;
Always wear a mask indoors (school, shops, offices etc.);
Wear a mask outdoors if safety distance cannot be guaranteed;
Wear a mask when entering a restaurant or café and take it off only when you are at the table.
Consent to the processing of personal data (Legislative Decree 196/2003 and EU Regulation No. 2016/679)