Screen Reader Mode Icon

Self-Screen for COVID-19

This screening tool must be completed by all visitors who intend to enter a St. Catharines SDA Church. Visitors are not permitted inside the building before completing this self-screen.

The health of our visitors depends on our honesty and accuracy in completing this screening tool. 

Thank you for your understanding and your commitment to the health of one another.

Question Title

* 1. Please enter your name.

Question Title

* 2. Have you been outside of Canada in the past 14 days?

Question Title

* 3. Has someone you are in close contact with tested positive for COVID-19?

Question Title

* 4. Do you live with someone who was tested for COVID-19 due to symptoms or close contact with someone who tested positive, and/or is awaiting their results?

Question Title

* 5. Do you have any of the following symptoms?
  • Fever / chills
  • Cough (new or worse)
  • Shortness of breath (even when sitting or walking regularly)
  • Sore throat
  • Runny nose/nasal congestion (not due to allergies)
  • Unusual level of fatigue
  • Unusual headache
  • Nausea / vomiting, diarrhea, or loss of appetite
  • Feeling unwell for an unknown reason

0 of 5 answered