CF Contact Tracing Form
In light of your diagnosis or positive test for COVID-19, Christ Fellowship requests that you disclose the location and with whom you had close contact so that we can advise any individuals of their potential exposure to the virus. They will only be provided with general information, and you will remain anonymous.

Please provide information for the 14 days prior to your diagnosis/positive test.
Email address *
Your Full Name *
Phone Number *
Select one of the following *
CF campus location you visited during the 14-day period *
Provide the exact date(s) you were present at the selected location *
Provide the exact area(s) within the campus you were at for more than 15 minutes at a time (Examples: Worship Center, Kids Nursery Room, Middle School Room, PB Offices) *
Provide names (if known) of individuals such as church staff, volunteers, guests, etc. with whom you had close contact (i.e., you were within approximately six feet for a prolonged period) *
Have you visited any other Christ Fellowship location/campus facility in the 14 days prior to your diagnosis/positive test? *
If yes, list the other location(s), area(s), date(s) of your visit, and names (if known) of individuals you had close contact with
Have you traveled to non-Christ Fellowship locations for ministry purposes in the 14 days prior to your diagnosis/positive test? *
If yes, list the other location(s), area(s), date(s) of your visit, and names (if known) of individuals you had close contact with:
Have you immediately notified all names listed above of possible exposure? If you answer no, please make sure to notify each person as soon as possible. *
Are you unable to work or telework due to your circumstance? You may be eligible to receive paid leave under FFCRA (until March 31, 2021) *
Any other important information you would like to include:
I certify that the above statements are true and correct.
Full Name: *
Today's Date: *
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A copy of your responses will be emailed to the address you provided.
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