Health Screening for Building Entry

Name

Date

Time

Reason for visit

Temperature

The CDC recommendations state that someone who was a suspected OR confirmed positive with COVID-19 AND had only mild symptoms can be around others after ALL of these conditions have been met:

- 10 days since symptoms first appeared
AND
- 24 hours with no fever without the use of fever-reducing medications
AND
- Any other symptoms of COVID-19 are improving.*

*Loss of taste and smell may persist for weeks or months after recovery and need not delay the end of isolation.

These recommendations do not apply to persons with severe COVID-19 or with severely weakened immune systems.

Are you fully vaccinated against COVID-19? (Fully vaccinated means you have received 2 doses of the Pfizer or Moderna vaccines OR one dose of the Johnson & Johnson vaccine AND it has been 2 weeks since your last dose.)

Yes No

Have you or anyone in your household traveled in the U.S. in the past 14 days?

Yes No

Have you or anyone in your household had contact within the last 14 days with any person under screening/testing for COVID-19, or with anyone with known or suspected COVID-19? Contact is defined as being within 6 feet (2 meters) for more than 15 minutes with a person, or having direct contact with infectious fluids from a person with confirmed/suspected COVID-19.

Yes No

To the best of your knowledge, do you have any reason to believe you or anyone in your household has been exposed to or acquired COVID-19?

Yes No

I have read and understand the procedures and policies for use of the Good Shepherd Christian Church building and property.

Agree

Description

Please fill out and submit before entering the building.

If you answered yes to any of these questions please do not enter the building. We have many members, families, and friends that are high risk for COVID-19 infection. For your safety and the safety of others we ask that you please come back at a time when you are feeling better and/or can answer "no" to all questions.

*If you are fully vaccinated and have come into contact with someone who has tested positive for COVID-19, the CDC recommends getting tested 3-5 days after your last exposure.*

If you answered no to all of the screening questions you may enter the building. Please follow the posted building policies while inside the building:

-Wear masks at all times
-Maintain physical distance of 6 feet when possible
-Wash/Sanitize hands upon entrance to building (soap and water for 20 seconds or hand sanitizer containing at least 60% alcohol)
-cover coughs and sneezes with an elbow
-avoid touching your face
-clean frequently touched surfaces often

Health Screening for Building Entry

Description

Please Fix the Following