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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.
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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?
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No. Continue to next question.
Yes, and I have received a negative result from a COVID-19 diagnostic test performed by a health care provider OR I have received 2 negative results from at-home tests taken at least 24hrs apart since the onset of symptoms AND have only mild symptoms (ie no runny nose; minimal non-productive cough; fever free for 24hrs without the use of medication). Go to the next question.
Yes, and it is Day 6-10 of isolation with mild symptoms (no runny nose; minimal, non-productive cough; fever free for 72 hours without the use of medication). You must wear an N95 grade mask in order to join us.
Yes, and I am not in the categories above. No further screening is required, you may not join us for services.
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
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No. Continue to next question
Yes, and it is Day 6-10 and I do not have any symptoms (or have mild symptoms that are improving). You must wear an N95 grade mask in order to join us for services.
Yes, and I am not in the categories above. No further screening is required, you may not join us for services.
In the past 5 days, were you in close contact with someone who tested positive for COVID-19?
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No. Continue to next question
Yes, I was exposed but am fully vaccinated, have tested negative on a diagnostic test and am not exhibiting any symptoms. You must wear an N95 grade mask in order to join us for services.
Yes, I was exposed and I am NOT fully vaccinated. You may not join us for services until the end of your quarantine.
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**
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Yes, I am considered fully vaccinated
Yes and I have received the Booster shot
No. I'm not considered fully vaccinated
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A copy of your responses will be emailed to the address you provided.
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