1. Within the last 14-days, have you tested positive for COVID-19 or have you had close contact (without the use of appropriate PPE) with others who have tested positive? (Note: Close contact is defined as within 6 feet for more than 10 consecutive minutes)
☐ YES ☐ NO
2. Are you or a member of your household awaiting COVID-19 test results or have you been told to self-isolate?
☐ YES ☐ NO
3. Do you live with someone who is sick at home with bronchitis-like or cold symptoms?
☐ YES ☐ NO
Have you experienced within the last 14-days, any of the following symptoms:
4. Fever (temperature at or above 100.4°) or the sense of having a fever?
☐ YES ☐ NO
5. Chills with shaking or teeth chattering?
☐ YES ☐ NO
6. A sore throat that you cannot attribute to another health condition?
☐ YES ☐ NO
7. A cough that you cannot attribute to another health condition?
☐ YES ☐ NO
8. Shortness of breath that you cannot attribute to another health condition?
☐ YES ☐ NO
9. Pain or tightness in your chest?
☐ YES ☐ NO
10. Flu-like symptoms?
☐ YES ☐ NO
11. Muscle pain that you cannot attribute to another health condition or a specific activity such as physical exercise?
☐ YES ☐ NO
12. Loss of ability to taste or smell?
☐ YES ☐ NO
If you answered “yes” to any of the questions above, you should not attend an in-person service.