Screening and Declaration Form
Please complete this form before you come back to Mass at our Parish for the first time since Covid Lockdown.
Email address *
Names of people in my household attending the public worship (including me). Must include full NAME of each person attending. *
Email address to contact should infection occur *
Cell Number to contact should infection occur *
Address *
Temperature will be taken before entry and must be lower than 37,4*C. I understand that if the temperature is 37,4*C or higher of any person in my household attending mass, we must be isolated and counselled as to monitoring and testing. *
I will social distance (2m) outside of church waiting for my turn to be screened and at all times during and after public worship. I must wear a face mask over my mouth and nose the entire time in church. For communion the priest will come to the pew to place the host into my left hand. I may briefly remove the face mask with my right hand to place the host into my mouth. *
On entering the church I will receive hand sanitizer and I will rub my hands for 20 sec before entering the church. I must bring my own hand sanitizer and paper towels or wipes. Before I leave after prayer after mass I will wipe down the pews where ever I touched them (usher will spray disinfectant). *
I will come to mass directly from home. I will not run errands beforehand, i.e. shopping. *
Screening- If the answers to any of the screening questions below is positive, I may not enter the Church, must be isolated, and counselled as to monitoring and testing. *
In the past 7 days have you or a member of your household experienced any of the following symptoms? *
In the last 14 days in your community, were you in close contact with or living with any of the following: (close contact means you were face-to-face i.e. less than 1 m with the person or you were in a close space, car, taxi or house for more than 15 min) *
In the last 14 days have you or anyone in your household been admitted to a hospital with severe pneumonia? *
In the last 14 days have you or anyone in your household worked in or attended a health care facility where Covid-19 patients are treated? *
Undertaking to Give Notice: I and everyone in my household have passed all the screening above. I undertake that should I or anyone in my household begin to experience any of these symptoms I will immediately notify the Parish Priest. I also understand that this is an important moral and legal obligation placed on me for the good of the community. I have read the above procedures and agree to comply with all health and safety measures. I am aware of, and accept all the risks associated with the pandemic: and I shall hold the Church, its employees and volunteers harmless, due to my voluntary attendance of public worship. *
Procedures for the admitting of parishioners back into Church for Mass
Agreement *
Volunteer - we welcome volunteers. Volunteers will receive training.
A copy of your responses will be emailed to the address you provided.
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