COVID-19 Health Questionnaire

Please respond to the following questions, so we may keep you and other congregants gathering with you safe and healthy. These questions are to screen for persons who could transmit the virus causing COVID-19. The information will remain confidential and reviewed only by your local clergy. The District Superintendent, Bishop/Cabinet, and Department of Health will review only if necessary.


1.) I acknowledge I have not had two or more of the following symptoms of COVID-19 in the past 14 days:


*Fever

*Shortness of breath or difficulty breathing

*Chills

*Persistent cough

*Flu-like symptoms

*Diarrhea or intestinal upset

*Fatigue

*Sore Throat

*Headache

*Muscle Pain

*Recent loss of taste or smell


2.) I have not been in contact with anyone experiencing symptoms of COVID-19 (identified above) in the past 14 days.


3.) I have not tested positive for COVID-19, nor am I awaiting test results, nor have I tested positive and have not subsequently had complete resolution of COVID-19 symptoms.


4.) I will immediately notify my pastor if after attending In-person Worship I develop 2 or more symptoms of COVID-19, will avoid contact with other and will seek medical attention.


I can answer YES to all of the above questions.


IF YOU CANNOT ANSWER YES TO THE ALL OF THE ABOVE, WE ASK THAT YOU WAIT BEFORE ATTENDING ANY IN PERSON GATHERINGS AT CHURCH UNTIL YOU CAN ANSWER AFFIRMATIVELY.