Daily Covid-19 Screening Questionnaire
Full Name *
Ministry Area Attending *
What is your temperature in F? *
Have you experienced any of the following symptoms within the last 48 hours? *
If the answer to any of the questions above is “yes”, please keep your child home and consult your primary care physician. If a doctor determines that your symptoms are due to another diagnosis, or COVID-19 is ruled out, your child may return to church activities after being fever-free for 24 hours without the use of fever-reducing medications.
Have you or anyone in your family been exposed to someone who has tested positive for COVID-19 in the last two weeks? *
Have you or any family member been out of the state in the last 14 days? *
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy