You have come to Bridge to Grace Church today for a specific church and ministry purpose, during the COVID-19 Pandemic. Please be advised of the following: while Bridge to Grace Church complies with State Health Department and the CDC infection control guidelines in effort to prevent the spread of the COVID-19 virus, we cannot make any guarantees. The ministry staff and visitors to Bridge to Grace Church are symptom-free and, to the best of their knowledge, have not been exposed to the virus. However, since we are a place of public accommodation, other persons could be infected, without their knowledge. In order to reduce the rick of spreading COVID 19, we are asking you a number of “screening” questions below. In effort to put the concern for others first, and then for everyone who is involved with Bridge to Grace Churches safety we ask you to answer these questions truthfully and then sign only if you are able.
- Have you experienced a fever of 100.4 degrees Fahrenheit or greater, a new cough, new loss of taste or smell, or shortness of breath within the past 10 days?
No. Go to next question.
Yes. No further screening is needed. The person may not enter. - In the past 10 days, have you tested positive for COVID-19 (10 days measured from the date you were tested, not the date you received the test result).No. Go to next question.
Yes. No further screening is needed. The person may not enter. - To the best of your knowledge, in the past 14 days, have you been in close contact (within 6 feet for at least 10 minutes) with anyone while they had COVID-19?No. Go to next question.
Yes. No further screening is needed. The person may not enter. - In the past 14 days, have you traveled internationally or returned from a state identified as having widespread community transmission of COVID-19? (https://coronavirus.health.ny.gov/covid-19-travel-advisory for applicable states).No. Go to next question.
Yes. No further screening is needed. The person may not enter.
By signing below I confirm that my answer to all above questions is NO.
Signature: ______________________________________________________________________ Date: _____________________
Temperature: ____________________________
