Shepherd of the Hills UMC

HEALTH ASSESSMENT FORM
 

These questions are provided as a guide for those considering attending any function at SHUMC, including worship. The questions should be considered before each incident of attendance.

 

  1. TRAVEL: Have you traveled away from Arizona to another state or outside the country in the past 14 days?

Was that travel to a place experiencing an outbreak of COVID-19? (This would be a sign that it would be prudent to stay home.)

 

  1. SYMPTOMS: Are you now experiencing, or have you experienced during the past 14 DAYS, ANY of these symptoms (this would be a sign that it might be prudent to stay home.)
  1. Fever, feeling hot, or feverish                                                      [ ] Yes                  [ ] No        
  2. Shortness of breath or difficulty breathing                                  [ ] Yes                  [ ] No
  3. Fatigue                                                                                         [ ] Yes                  [ ] No
  4. Cough                                                                                           [ ] Yes                  [ ] No
  5. Sore throat                                                                                   [ ] Yes                  [ ] No
  6. Congestion or runny nose                                                            [ ] Yes                  [ ] No
  7. Headache                                                                                     [ ] Yes                  [ ] No
  8. Muscle or body aches                                                                   [ ] Yes                  [ ] No
  9. Recent loss of taste or smell                                                        [ ] Yes                  [ ] No
  10. Nausea or vomiting                                                                     [ ] Yes                  [ ] No
  11. Diarrhea                                                                                      [ ] Yes                  [ ] No

 

  1. CONTACT: Have you come in contact with someone experiencing symptoms of COVID-19 (see above) in the past 14 days? (This would be a sign that it would be prudent to stay home.)
 
 
  1. TESTING:
    1. Have you tested positive for COVID-19 within the last 14 days?
    2. Are you waiting for results from a COVID-19 test?
      (Either of these would be a sign that it would be prudent to stay home.)

 

  1. If you develop two or more of the common symptoms of COVID-19 listed above, you
should immediately seek medical attention and ensure that you avoid contact with others.
 

If you have attended any church event within 14 days of developing the symptoms, please immediately contact the church office to let us know, so that we can ensure the safety of others.