Eastside Church of Christ Garland, TX
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Coronavirus Screening Questionaire
*
Indicates required field
Name
*
First
Last
1. Cough?
*
Yes
No
N/A
2. Shortness of breath or difficulty breathing?
*
Yes
No
N/A
3. Chills?
*
Yes
No
N/A
4. Repeated shaking with chills?
*
Yes
No
N/A
5. Muscle pain?
*
Yes
No
N/A
6. Headache?
*
Yes
No
N/A
7. Sore throat?
*
Yes
No
N/A
8. Loss of taste or smell
*
Yes
No
N/A
9. Diarrhea?
*
Yes
No
N/A
10. Feeling feverish or measured temperature of greater that 99.6° F?
*
Yes
No
N/A
11. Have you been in close contact with a person who has tested positive (lab confirmed) to have Novel Coronavirus?
*
Yes
No
N/A
12. Have you tested positive for the Coronavirus?
*
Yes
No
N/A
13. Have you been cleared by the Health Department of you tested positive for the Coronavirus?
*
Yes
No
N/A
14. Have you had a follow up negative test?
*
Yes
No
N/A
15. Have you traveled outside of Texas within the last 14 days?
*
Yes
No
N/A
16. Have you spoken to your doctor about any of your symptoms or travel?
*
Yes
No
N/A
If any member is presenting with any symptom(s) upon arrival to worship service as stated above, he or she will be assessed by medical team, and asked by leadership team to attend alternative worship service.
This will be expected and not optional
Submit
Home
Contact Us
Forms
Update Your Contact Info
Leadership
Our Elders
Our Deacons
Ministries
Forms
Evangelism Outreach