HECSD COVID-19 Self Evaluation Questionnaire�聖雅福音教會COVID-19自我評估問卷
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Complete this assessment before going to church  上教堂之前請完成並提交此評估
Have you finished COVID-19 vaccination? 你打過COVID-19疫苗了嗎？
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In the past two weeks, have you experienced any of the following at greater intensity or frequency than what you normally experience: cough, shortness of breath or trouble breathing, fever of 100°F or higher, chills, muscle pain, sore throat, new loss of taste or smell?  在過去的兩周內，您是否經歷過以下任何一種強度或頻率比平常更高的：咳嗽，呼吸短促或呼吸困難，發燒100°F或更高，發冷，肌肉疼痛，喉嚨痛，新失去的味道或氣味？ *
Yes （有）
No （沒有）
我的回答
Have you been in close contact with anyone who was diagnosed with or tested positive for COVID-19 in the last 14 days, or placed in isolation, or in an official quarantine at home? (i.e. due to travel to a high risk location, suspected COVID, exposure to COVID, etc? ) 在過去的14天內，您是否與被診斷出COVID-19陽性或測試陽性的人有過密切接觸，或在家隔離, 或檢疫? (刚从高危險地區回来,或可能感染新冠病毒？) *
Yes （有）
No （沒有）
我的回答
Name (Last, First, Phone No.) 姓名 電話 *
If you answered “No” to both questions above, you may go to church. If you answered “Yes” to one or both questions above, you should stay at home.  God bless and thank you!  如果对以上两个问题回答都是“没有”, 請按計劃去教会。 如果对以上任何一个问题回答了“有”, 请留在家里。愿神与你同在, 谢谢!
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