Believers Missionary Baptist Church COVID-19 Screening Questionnaire

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Please Submit Screening Questions for Review no more than 2 Days Prior to the Sunday you Plan to Attend Onsite Worship Services

Email *

Name *

In the last 14 days, have you or anyone in your household traveled outside of the United States or to any area of United States where COVID-19 cases are very high? *

Yes

Required

Within the last 14 days, have you had close contact with anyone who is currently sick with suspected or confirmed COVID-19? *

Yes

In the last 14 days, have you been exposed to anyone with COVID-19? *

Yes

In the last 14 days, has a medical professional advised you to self-quarantine?

Yes

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Are you currently experiencing, or have you recently experienced any of the following symptoms: fever of 100.4 or greater, cough, sore throat, shortness of breath or difficulty breathing, chills, repeated shaking with chills, muscle aches, headache(not contributed to a chronic condition such as a migraine), new loss of taste or change in taste or smell, or any other symptoms of illness? *

Yes

In the last 14 days, have you been advised by a healthcare professional to seek COVID-19 testing?

Yes

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