COVID-19 Screening — #INNTHEHOUSE

COVID-19 SCREENING QUESTIONNAIRE

All persons attending an in-person meeting, worship experience or other activity located inside of the facilities at Innovation Church are required to complete a COVID-19 screening which includes a temperature check and brief questionnaire.

PLEASE NOTE: ATTENDEES MUST COMPLETE COVID SCREENINGS INDIVIDUALLY AND NOT AS A FAMILY. (ex: 5 persons attending = 5 individual screenings)

Name

First Name

Last Name

Phone

(###)

###

####

Did you or anyone in your household test positive for COVID-19 in the last 14 days?

YES

NO

Have you had any of the following symptoms in the last 14 days: sore throat, cough, chills, body aches for unknown reasons, shortness of breath for unknown reasons, loss of smell, loss of taste, fever of 100.4 degrees or greater?

YES

NO