Waiver Application/Guidance Document

Entertainment Venues and Multi-Purpose Facilities

Name of Establishment

Name of Event

Date of Event

Time/Hours

Phone Number

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PLAN GUIDANCE

Seating chart/blueprint included with waiver application?

Yes

Requirements include the following:

Maximum of 6 patrons per group/table and preferably from the same household
At least 6 feet between groups/tables
All patrons must be seated
Maximum of 50 people sharing common areas where people may be able to congregate (i.e., seating, concessions, restrooms)
Normal seating capacity

Seating chart for performers included with waiver application?

Yes

Requirements include the following:

Seating not allowed within 10 feet of the stage – barricades desired
Limit of 10 performers on stage (must practice social distancing – at least 6 feet in all directions and no contact during performances

Describe how you will screen employees, guests, and performers for COVID-19 symptoms and discourage people who are ill from entering, and policies for staff who report illness:

Requirements include the following:

Post signage at entrances for guests regarding symptoms of COVID-19
Employee must complete COVID-19 symptom screening prior to beginning work
Performers must complete COVID-19 symptom questionnaire prior to performance
Sick leave policies

Describe protocols that will be in place to prevent the spread of COVID-19 during business hours and an event.

Requirements include the following:

Public and employee areas must be set up to encourage social distancing and prevent congregating.
Employees must be provided with appropriate personal protective equipment or face coverings.
Hand hygiene supplies must be readily available.
Social distancing and face coverings are required.

Describe your guest tracking policy:

Describe how you will enforce face covering and social distancing policies and prevent loitering:

Describe how you will isolate ill individuals and transport an ill individual(s) away from the facility:

Describe your cleaning and disinfection plan:

Describe your protocol for how you will manage an employee or patron reporting being sick with COVID-19 while working or attending an event at your venue:

**DC Health will not approve plans that promote large gatherings, congregating and do not support appropriate and adequate safeguards and social distancing**

Acknowledgement and Attestation Form

This form must be signed and notarized as a prerequisite to the waiver approval

The undersigned certifies under the penalty of perjury, that the facility has met all requirements as outlined in the application.
The undersigned certifies that they are aware that DC Health and any District of Columbia agency shall suspend activities if non-compliance is observed during the event. The term “non-compliance” includes deviation from the approved waiver.
The undersigned chooses to sign this attestation willingly and without reservation and is fully aware of its meaning and effect.

Signature of Owner or Manager:

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

Company Name

Title

Date Picker