RSVP 2 — 證道浸信會美城堂

LBCM Covid-19 Checklist

證道浸信會美城堂疫情検測問卷

Please complete the following questions, selecting an answer for each line

請完成以下問題，為每一行選擇一個答案

Name 姓名

First Name

Last Name

Email 電郵

Phone 電話

(###)

###

####

1. Have you experienced a fever, and / or respiratory symptoms such as cough, sore throat, difficulty in breathing in the past 14 days?

您在过去 14 天内是否有发烧和/或呼吸道症状，例如咳嗽、喉咙痛、呼吸困难？

2. Have you traveled outside of the province within the past 14 days?

过去 14 天内您是否曾到省外旅行？

3. Have you been in close contact (within 6 feet for 15 minutes at a time ) with a person who have been confirmed or waiting on COVID – 19 test results?

您是否与已确诊或等待 COVID-19 检测结果的人密切接触（每次 6 英尺以内，持续 15 分钟）？

4. Under current provincial health guidelines, should you currently be in self-isolation or quarantine?

根据目前的省级卫生指南，您目前应该自我隔离还是隔离？

Do not enter the church if you answer YES to any of the about question.

如果您对以上任何问题的回答是“是”，请不要进入教堂。

By checking there, I agree and acknowledge that I enter the church at my own risk and I release and forever discharge the church of and from any and all liability and claims with respect to all COVID – 19 and related matters

通过填寫這個核查清單，我同意并確定我自担风险进入教堂，我解除并永远免除教会对所有 COVID-19 及相关事项的任何和所有责任和索赔

Agree 同意

Reason for Access:

進入教會原因

Estimated In Date

預計進入教會日期

YYYY

Estimated In Time

預計進入教會時間

Hour

Minute

Second

Estimated Out Time

預計離開時間

Hour

Minute

Second