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Assessment
To be submitted on Sunday before entering the church building. Family groups can use the same form if the answer is true for all people listed.
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Email *
Phone Number *
Name *
Names of others in your family or group
Today's date in 2022 *
Do you have any of the following symptoms: fever, shortness of breath, or difficulty breathing? *
Do you have two (2) or more of the following symptoms: Sore throat, hoarse voice, difficulty swallowing, loss of sense of smell/taste? *
In the last 14 days, have you been in close physical contact with someone who either is currently sick with new COVID-19 symptoms (like a cough, fever, or difficulty breathing) or who has returned from outside of Canada in the last 2 weeks with new COVID-19 symptoms (like a cough, fever, or difficulty breathing)? *
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