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TSR Health Screening

TSR Health Screening

Temple Sinai Health Screening & Contact Tracing Form:
Celebration of Life Pastor Victor Lewis
 
Please read each question carefully and select the honest answer. If you decline to submit this screening, you will be denied entry to Temple Sinai's facility.
 
Have you experienced any of the following symptoms in the past 48 hours: fever, chills, shortness of breath, difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, diarrhea?

 
Within the past 14 days, have you been in close physical contact (6 feet or closer for a cumulative total of 15 minutes) with anyone who is known to have laboratory-confirmed COVID-19 OR anyone who has any symptoms consistent with COVID-19?

 
Are you currently waiting or quarantining because you may have been exposed to a person with COVID-19 or are you worried that you may be sick with COVID-19?

 
Have you violated CDC travel guidelines within the last 14 days?

If you have a chronic medical condition that causes COVID-19 like symptoms and you need to enter Temple Sinai, please provide the Executive Director (lmirrer@mysinai.org) proof of clearance from a medical professional. 

If you meet the criteria to enter, you will sanitize hands upon entry, wear a mask at all times (must fit securely over nose and mouth), and maintain a social distance from others of at least six feet. 
By signing below, you CONFIRM ACCEPTANCE of this policy. 
 

 

Wed, May 1 2024 23 Nisan 5784