Church in LA Corporate Housing Health Protocol Agreement Form
While we believe and trust in the Lord that He will cover us, we also want to be vigilant and do whatever we can to prevent any spread of disease among our community, the church life, and corporate living. This is not a time to panic, but to be prepared in a serious way. Please join us in praying for our health and safety as well as for the Lord's sovereign will to be done on earth.
Address of your housing unit:
Do you suspect that you yourself or anyone that you may have had contact with could have Covid-19?
Please check all of the boxes below indicating your agreement to regularly practice these items both for the sake of ourselves and for our care for one another:
Frequently wash hands with warm, running water. Hands should be rubbed vigorously during washing for at least 20 seconds. Remember to wash the back of the hands, wrists, between the fingers, and under the fingernails.
Refrain from touching eyes and mouth as much as possible.
Cover my mouth when I cough or sneeze. Cough/sneeze into a tissue or into my elbow rather than my hands.
I will not to invite any sick friends, saints, etc over to the house. All guests who are invited over must be symptom free for at least 48 hours or they will not be allowed to come.
For any small group meetings I host at the house, I will make it clear to the small group that anyone exhibiting signs of a cold or flu should not come.
Thoroughly clean and disinfect all surfaces in the guest bathrooms and kitchen as well as all door handles on the first floor after hosting a small group meeting downstairs at the sisters' house.
If my roommate becomes sick (and has not been diagnosed with Covid-19), I am willing to temporarily move to a different room in order to stay well.
If a housemate who shares my bathroom becomes sick (and has not been diagnosed with Covid-19), I am willing to temporarily move to another bathroom.
I agree to a health screening process for any non-residents of the house who would like to spend the night at the house. They must fill out the form at:
I agree to use the dishwasher as much as possible to wash dishes since the high temperature and soap will kill the maximum amount of germs.
Daily disinfect handles, light switches, counters, bathrooms. Need to set up a schedule.
Where are you planning on going during your spring break? Please list all cities.
WHAT TO DO IF I AM SICK, HAVE A COLD, AND/OR HAVE FLU SYMPTOMS:
If I have any of the these symptoms: Sore throat, fever, coughing, shortness of breath, respiratory problems, I agree to:
Notify my house coordinator immediately
Notify my roommate (if I have one)
Notify those who share my bathroom.
If I am sharing a room, I am willing to consider moving to a quarantine room to protect my roommate(s)
Minimize my usage of kitchen surfaces, cooking utensils, etc. I agree to thoroughly wash with HOT water all of the items I use and to disinfect any surfaces I touch.
Ask for help via text/phone as much as I need it, but I know I must limit any in-person contact with others. I know that my housemates are here to help me, including with things like grocery shopping, etc. But they will need to stay away from me in order to protect themselves.
Not attend any meetings while sick. I can return to meetings only after I have not exhibited any fever for at least 48 hours and am not taking an medications to address that.
Consider if I have any reason to believe I was in contact with anyone who had Covid-19.
Minimize my interaction with people person-to-person. I will use my phone/computer/technology as much as possible for necessary contact with others.
MY PLANS IF I CONTRACT COVID-19 OR AM EXPOSED TO SOMEONE WHO IS:
I agree to immediately notify my housing coordinator
Please tell me more about this
I agree to seek immediate treatment from a medical professional.
I have challenges in this area and need some help.
I recognize that a 14 day quarantine period is mandatory for anyone who contracts Covid-19 or is exposed to some who has it.
If necessary, I prefer to be quarantined:
In a bedroom at my corporate housing unit
At home with my parents.
I acknowledge that the following conditions must be adhered to should I need to be quarantined:
Limit visitors to only people caring for the patient (me)
As much as possible, anyone who is not caring for the patient should stay in another home or stay in other rooms. They should also use a separate bathroom if possible.
Keep elderly people and those who have weak immune systems or chronic health conditions away from the person. This includes people with diabetes, chronic heart or lung or kidney conditions.
Avoid sharing household items. Do not share dishes, drinking glasses, cups, eating utensils, towels, bedding, or other items with other people in the home. These items should be washed thoroughly after use with soap and warm water
Clean all “high-touch” surfaces, such as counters, tabletops, doorknobs, bathroom fixtures, toilets, phones, keyboards, tablets, and bedside tables, every day using household disinfectants.
Also, clean any surfaces that may have blood, body fluids and/or secretions or excretions on them.
I will minimize any time in all corporate areas of the house
I will spend all of my time in my bedroom except for absolutely necessary visits or excursions during my full quarantine period.
I will ask for help via my phone/computer and realize I need to ask others to help with errands, etc so that I will not need to leave my room.
OTHER IMPORTANT CONSIDERATIONS:
If my classes are canceled or are moved completely online, I would most likely:
Like to return home to be with my parents
Stay in my corporate housing unit.
Please check all of the following to indicate your agreement to each statement:
I agree to love, care for, and be respectful of all members in my housing unit without favoritism.
I will not make fun of anyone who is sick or needs to be in quarantine.
I will treat all of my own health issues and the health of others with the utmost sobriety and seriousness.
I realize that I may need to sacrifice many of my own conveniences for the safety of the residents of the house and the saints who come to the house.
I am willing to support others in the house according to my ability and availability in case of a need, but I know that I will not be able to physically contact them in any way. All my care will be through phone/computer.
I will notify my parents or closest relatives regarding this protocol, sharing the link to this form with them and notifying them that I have filled it out.
Do you have any other comments or questions?
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