ESCC SERVICE'S SCREENING REGISTER
I agree that I enter the premises of El Shaddai Christian Church & School at own risk
I understand that my temperature will be taken and I must record it, together with other symptom screening for ESCC’s record keeping.
I agree to adhere to COVID-19 response strategies that El Shaddai Christian Church & School has put in place to ensure a safe working and schooling environment for all staff and learners.
I will sanitize my hands after screening and before entering the building
I will keep my 2 layer cloth mask on at all times and I will ensure that it covers my nose and mouth at all times. If it does not fit properly, or is not according to the church/ school’s satisfaction, they may issue me with a temporary one.
I will keep a social distance of at least 1,5 m at all times and make no direct contact with any other person besides my own family living in my home.
I will inform a staff member should I start presenting with any of the COVID-19 symptoms during my attendance.
Name *
Surname *
Contact Number *
Temperature *
Residential Address *
Spouse Name
Spouse Temperature
Child #1 Name
Child #1 Temperature
Child #2 Name
Child # 2 Temperature
Child #3 Name
Child # 3 Temperature
Child #4 Name
Child # 4 Temperature
Do you or any of your family members have a fever (temperature of 37.8 C or higher) OR any new/worsening symptoms including cough, shortness of breath, sore throat, difficulty swallowing, hoarse voice, runny nose, stuffy or congested nose, lost sense of taste or smell, digestive issues such as nausea/vomiting or diarrhea, stomach pain. Other symptoms may include: fatigue, falling down more than usual, chills, headache * *
If you answer 'No' to the above question:  You are permitted to enter. Please continue to practice physical distancing and self-monitor for symptoms. PLEASE INFORM ANYONE ON STAFF IF YOU DEVELOP SYMPTOMS WHILST AT THE MEETING. If you answer 'Yes' to the above question for yourself or any of your family members: Go home. DO NOT ENTER TO THE FACILITY. Please Sign your name Below *
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