COVID-19 Notification Form – Redeemer Church

COVID-19 NOTIFICATION FOR CONTRACT TRACING

Thank you for helping us to keep everyone safe by letting us know about your diagnosis or exposure to COVID-19. This form is submitted to one person on our administrative staff responsible for contract tracing and your identity and information provided will remain fully confidential as others are notified of their possible exposure during a Sunday visit.

*
First Last
Email*
Phone*
Let us know if you have been diagnosed with or exposed to COVID-19 then answer the applicable questions below.
- I have been diagnosed with COVID-19
- I have been exposed to COVID-19
What was the date of the last service you attended?*
MM slash DD slash YYYY
Which service time did you attend?*
- 9:00 AM
- 11:00 AM
What approximate date were you diagnosed or exposed?*
MM slash DD slash YYYY
If you know, provide names of the people who were in closest proximity to you on the Sunday you attended before your diagnosis or exposure. This would be especially helpful if you attended a small group meeting on your Sunday visit.
If you know, provide names of the people who were in closest proximity to you on the Sunday you attended before your diagnosis or exposure. This would be especially helpful if you attended a small group meeting on your Sunday visit.
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COVID-19 NOTIFICATION FOR CONTRACT TRACING

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