FLC Group Meeting Health Check-in
Please fill out a new form every Day you are attending a group meeting at FLC. If you answered "Yes" to any questions, please stay home. Thank you!
What group are you meeting with? (example: Quilters, MaryUnit, First Lutheran Youth (FLY), etc...) *
Today's Date *
MM
/
DD
/
YYYY
Name *
Email address or Phone Number *
Please check participant's temperature. Is anybody's temperature 100.4ºF or higher? *
Does anyone in your household have potential symptoms of COVID-19; such as fever, shortness of breath, persistent dry cough, etc. in the 72 hours prior to today? *
Has anyone in the household been diagnosed with COVID-19 within the last 12 days? *
Have you taken any fever reducing medications such as acetaminophen or ibuprofen in the past 24 hours? *
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