AHOP Wellness Survey
Please complete this survey at earliest 48 hours prior to entry to the Church Building. Electronic signature ensures all statements and responses are accurate to protect the health of yourself and others. If you have recently experienced any symptoms please stay home. Masks and face coverings are required for duration of time inside the building. Sanitation of hands are required upon entry and temperature checks will be conducted. Denial of entry will be permitted for excessive temperature or refusal to comply with guidelines. TO PREVENT THE SPREAD OF THE COVID-19 AND TO HELP PROTECT OTHERS, I AGREE TO FOLLOW THE AHOP GUIDELINES. I UNDERSTAND, READ, AND COMPLETED THIS SURVEY TRUTHFULLY. I WILL TAKE RESPONSIBILITY FOR MY ANSWERS AND HOLD AHOP HARMLESS.
In the past 14 days, have you experienced any flu-like symptoms. (Fever or chills, Cough, Shortness of breath or difficulty breathing, Fatigue, Muscle or body aches, Headache, New loss of taste or smell, Sore throat, Congestion or runny nose, Nausea or vomiting, Diarrhea)
Please Enter Today's Date
Please Provide Your Email Address
Will you adhere to CDC guidelines for social distancing and other preventative measures to reduce the spread of COVID-19?
Please Enter Your Full Name
Have You Received A COVID-19 Vaccine Shot?
If You Have Received a Vaccine Shot, Which Vaccine did you receive?
Johnson & Johnson
Which COVID-19 Vaccine Shots have you received today?
Both 1st and 2nd Shot
Should be Empty: