FJC Health Screening Questionnaire
As part of the sign-up process for any of our services, whether indoors or outdoors, this form must be completed  every Friday (or the day a holiday starts), not later than 15 minutes before sundown.
Sign in to Google to save your progress. Learn more
Email *
Have you experienced any symptoms of COVID-19, including a fever of 100.0 degrees F or greater, a new cough, new loss of taste or smell or shortness of breath within the past 5 days? *
In the past 5 days, have you gotten a positive result from a COVID-19 diagnostic test? *Please note that 10 days is measured from the day you were tested, not from the day when you got the test result *
In the past 5 days, were you in close contact with someone who tested positive for COVID-19? *
Are you considered fully vaccinated against COVID-19 by CDC guidelines?  Please note that in order to be considered fully vaccinated by CDC guidelines, two weeks must have passed since you received the second does in a two-dose series or two weeks must have passed since you received a single dose vaccine.  **If you are 18+ and are not fully vaccinated, you may join us for services but will not be able to join us for kiddush and lunch** *
A copy of your responses will be emailed to the address you provided.
Clear form
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy