Name*
These questions are to screen people who could transmit the virus causing COVID-19. The information will remain confidential and reviewed only by the pastor(s), the healthy church team, or the Department of Health for possible contact tracing. Persons who have 2 or more of the listed symptoms or who have been in contact with anyone experiencing symptoms of COVID-19 in the past 14 days are encouraged to worship online only.
Email*
Phone*( ) -
Fever, feeling hot, feverish
Shortness of breath, difficulty breathing
Cough
Flu-like Symptoms: diarrhea, intestinal upset, or fatigue
Sore Throat
Headache
Muscle Pain
Recent loss of taste or smell
Please check any of the following symptoms you are experiencing, or have experienced during the past 14 DAYS:
Testing Results for COVID-19* I tested positive for COVID-19 I tested negative for COVID-19 I have or had symptoms of COVID-19 and I am waiting for results for COVID-19 If tested positive for COVD; will share with pastor(s)
Yes, I did bring children.
No, I did not bring children
I affirm we share the same response to the questions above.