Health and Wellness Self Screening Certification for All Visitors to All Saints Buildings
We are asking all visitors who come to the church or Parish House to self-screen for COVID-19 symptoms until further notice. This is in an effort to continue taking safety measures; we are taking an abundance of caution to be sure you, your family, our community are safe.
By signing this form, you certify that you have screened yourself by using the following checklist before you come to All Saints. This form must be signed each day you come to All Saints.
- I have had no signs or symptoms of ANY of the following within the last 24 hours: fever above 100.4 degrees, shortness of breath or difficulty breathing, persistent cough, chills, sore throat, muscle pain, or new loss of taste or smell. (If more symptoms are updated by the CDC or other public health agencies, we will include those symptoms as well.)
- If any one of the symptoms manifests while I am at All Saints, I must self-isolate and inform the leader of the group or a staff person immediately. If it is safe for me to leave the premises on my own, then I will do so without delay. Otherwise, arrangements will be made for my safe departure.
- I have not had close contact with an individual diagnosed or suspected positive of COVID-19 within the past 14 days.
Close contact means: living in the same household, caring for, being within 6-feet, or coming in direct contact with secretions (e.g. sharing utensils, being coughed on, etc.) of a person who has tested positive for COVID-19 while that person was symptomatic.
- I have not been asked to self-isolate or quarantine by a doctor or health official.
- I acknowledge that I have not traveled for an extended period of time outside the Commonwealth of Massachusetts in the past 14 days.
NOTE: Individuals exhibiting symptoms or unable to self-certify will be directed to leave and seek medical attention and applicable testing by their health care provider. They are not to return until proper information is provided to All Saints. We want to be sure we are following the guidance from local, state, and federal agencies for the safety of all.
I attest that I have checked this list, and acknowledge that if I cannot certify any of the items above, that I will not be allowed into the buildings of All Saints. I understand my name and phone number will be kept in a confidential file by All Saints Parish for 28 days solely for the purposes of contact tracing, should the need arise, and then purged.