新冠病毒篩查表格(粵語)EACO Covid-19 Screening Form (Cantonese)
凡參加在教會舉行的實體團契、會議或崇拜聚會之前,請填寫此篩檢表格。每位12 歲或以上的人填一份。
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 *
聯絡電話 Contact phone number *
預定出席日期  Intended Date of Attendance *
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1. 您或您家中的任何人是否有一種或多種這些新的或惡化的症狀(與其他已知原因或狀況無關)?發燒/發冷、咳嗽、呼吸困難、嗅覺和味覺減少/喪失     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兩種或多種這些新的或惡化的症狀(與其他已知原因或狀況無關)?打噴嚏,喉嚨痛,頭痛,非常疲倦,流鼻涕/鼻塞,肌肉酸痛/關節痛,噁心/嘔吐/腹瀉     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. 在過去的14天裡,你是否在加拿大境外旅行過,並且按照聯邦檢疫要求進行隔離(只適用於未完全接種疫苗的旅客)?    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. 在過去 5 天內(如果您未完全接種疫苗且年滿 12 歲或免疫功能低下,則為 10 天),您或您家中的任何人是否在快速抗原檢測或 PCR 中檢測出 COVID-19 呈陽性測試?  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. 在過去 5 天內(如果您未完全接種疫苗且年滿 12 歲或免疫功能低下,則為 10 天),您是否在手機上收過 COVID 追蹤警報通知?  (如果您已完全接種疫苗,請回答“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. 在過去 5 天內(如果您未完全接種疫苗且年滿 12 歲或免疫功能低下,則為 10 天),您是否被確定為已檢測並被確認為COVID-19 呈陽性人員的“密切接觸者(高風險接觸者)” ?如果您已完全接種疫苗並且不與檢測呈陽性或有症狀的人住在一起,請回答“否”。 如果公共衛生部門建議您不需要自我隔離,請回答“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.  您今天帶了多少 12 歲或以下的孩子來? How many children of age 12 or under are with you today?
重要事項:  如果你對以上任何一個問題回答“是”,請你留在家中參加網上崇拜。 通過同意: (1) 我確認以上提供的所有信息都是準確的; (2) 並且同意在進入禮堂時,遵守主恩堂制定的政策和程序; (3) 如我稍後經測試並確診感染新冠病毒,我同意立刻以電郵(office@eaco.ca)通知渥太華主恩宣道會。   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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