UABC Worship - Covid19 Screening
This form is a way for us to be at our best as a faith family. With this screening questionnaire, we can ensure a safe environment for one another, make our accountability to each other quick & easy, and provide a means for contact tracing, if necessary. Completion of this form (or a paper version) is required before attending a UABC worship service.
Name *
Today OR in the past 2 weeks OR since your last screening, have you had any of the following symptoms?
Have you been in close contact with anyone who has been diagnosed with COVID-19 in the past 2 weeks? *
If YES to any of the above symptoms or questions, please note any details:
Most recent thermometer reading & when taken:
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