This screening tool is intended to help determine if a visitor or member is in good health (e.g., does not have COVID-19) prior to attending an in-person church service. It will also help us keep record of those who attend services, should we need to provide information in the event of community spread of COVID-19.
Full Name (First and Last)
Do you have a fever (e.g., 37.8 degrees celcius or greater)?
Please check each box if you DO NOT show the symptom.
I DO NOT have these symptoms:
new or worsening cough
shortness of breath
runny nose or sneezing
new smell or taste disorder(s)
nausea, vomiting, diarrhea, or abdominal pain
unexplained fatigue / malaise
Have you travelled in the last 14 days?
Have you had close contact with anyone that has travelled domestically or internationally in the past 14 days?
Have you had close contact with anyone with a respiratory illness; a confirmed case (or a case being investigated) of COVID-19?
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