COVID Screening Form

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COVID Screening Form

Daily screening form for staff and visitors to Trinity United Church

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* Indicates required question

Please enter your name *

Your answer

Please enter your email address or telephone number (for contact tracing purposes) *

Your answer

Do you have any of the following New or Worsening Symptoms? *

Fever or Chills

Difficulty Breathing or Shortness of Breath

Cough

Sore Throat or Trouble Swallowing

None of the above

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