新冠病毒筛查表格(国语)EACO Covid-19 Screening Form (Mandarin)  
凡参加在教会举行的实体团契、会议或崇拜聚会之前,请填写此筛检表格。 每位12 岁或以上的人填一份。
Please complete screening before attending in-person fellowships, meetings or worship services at church.
One form for each person (age 12+) [version_2204]
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Email *
姓名 Name *
联络电话 Contact phone number *
预定出席日期  Intended Date of Attendance *
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1. 您或您家中的任何人是否有一种或多种这些新的或恶化的症状(与其他已知原因或状况无关)?发烧/发冷、咳嗽、呼吸困难、嗅觉和味觉减少/丧失     Do you or anyone in your household have ONE OR MORE of these new or worsening symptoms (not related to other known causes or conditions)? Fever/Chills, Cough, Difficulty Breathing, Decrease/loss of smell and taste *
2.  您或您家中的任何人是否有两种或多种这些新的或恶化的症状(与其他已知原因或状况无关)?打喷嚏,喉咙痛,头痛,非常疲倦,流鼻涕/鼻塞,肌肉酸痛/关节痛,恶心/呕吐/腹泻     Do you or anyone in your household have TWO OR MORE of these new or worsening symptoms (not related to other known causes or conditions)? Sneezing, Sore throat, Headache, Very tired, Runny/stuffy nose, Muscle aches/Joint pain, Nausea/vomiting/diarrhea *
3. 在过去的14天里,你是否在加拿大境外旅行过,并且按照联邦检疫要求进行隔离(只适用于未完全接种疫苗的旅客)?      In the last 14 days, have you travelled outside of Canada AND are required to quarantine per the federal quarantine requirements (only applied to not fully vaccinated travellers)? *
4. 在过去 5 天内(如果您未完全接种疫苗且年满 12 岁或免疫功能低下,则为 10 天),您或您家中的任何人是否在快速抗原检测或 PCR 中检测出 COVID-19 呈阳性测试?     In the last 5 days (10 days if you are not fully vaccinated and 12 years of age and older or if you are immunocompromised), have you or anyone in your household tested positive for COVID-19 on a rapid antigen test or PCR test? *
5. 在过去 5 天内(如果您未完全接种疫苗且年满 12 岁或免疫功能低下,则为 10 天),您是否在手机上收过 COVID 追踪警报通知? (如果您已完全接种疫苗,请回答“否”。 )       In the last 5 days (10 days if you are not fully vaccinated and 12 years of age and older or if you are immunocompromised), have you received a COVID Alert exposure notification on your cell phone?              (If you are fully vaccinated, answer "No". ) *
6.  在过去 5 天内(如果您未完全接种疫苗且年满 12 岁或免疫功能低下,则为 10 天),您是否被确定为已检测并被确认为COVID-19 呈阳性人员的“密切接触者(高风险接触者)” ? 如果您已完全接种疫苗并且不与检测呈阳性或有症状的人住在一起,请回答“否”。如果公共卫生部门建议您不需要自我隔离,请回答“否”。    In the last 5 days (10 days if you are not fully vaccinated and 12 years of age and older or if you are immunocompromised), have you been identified as a “close contact (high risk contact)” of someone who has tested positive for COVID-19?  If you are fully vaccinated AND DO NOT live with the person who tested positive or has symptoms, answer "No".  If Public health has advised you that you do not need to self-isolate, answer “No”. *
7.  您今天带了多少 12 岁或以下的孩子来?      How many children of age 12 or under are with you today?
重要事項:  如果你对以上任何一个问题回答 “是”,请你留在家中参加网上崇拜。通过同意: (1) 我确认以上提供的所有信息都是准确的; (2) 并且同意在进入礼堂时,遵守主恩堂制定的政策和程序; (3) 如我稍后经测试并确诊感染新冠病毒,我同意立刻以电邮(office@eaco.ca)通知渥太华主恩宣道会。               IMPORTANT:  If the answer to any of the above questions is "Yes", you should stay at home and attend the worship service online. By agreeing, I acknowledge that:  (1) all information provided above is accurate, (2) I have agreed to follow the protocols and procedures put in place by EACO upon entering the worship sanctuary, and (3) I also agree to inform EACO (office@eaco.ca) immediately, if I am later tested or diagnosed COVID-19 positive.
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