YOU MUST COMPLETE ONE FORM FOR EACH PARTICIPANT/EMPLOYEE ATTENDING KADIMAH JCAMP.

THE FORM MUST BE COMPLETED THE SAME DAY AS YOUR ATTENDANCE

Participants/Employees will not be permitted on-site without a completed COVID-19 Screening Questionnaire.


  • Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or higher

  • Not related to asthma, post-infectious reactive airways, COPD, or other known causes or conditions you already have

  • Not related to asthma or other known causes or conditions you already have

  • Not related to seasonal allergies, acid reflux, or other known causes or conditions you already have

  • Painful swallowing (not related to other known causes or conditions you already have)

  • Not related to seasonal allergies, neurological disorders, or other known causes or conditions you already have

  • Conjunctivitis (not related to reoccurring styes or other known causes or conditions you already have)

  • Not related to seasonal allergies, being outside in cold weather, or other known causes or conditions you already have

  • Unusual, long-lasting (not related to tension-type headaches, chronic migraines, or other known causes or conditions you already have)

  • Not related to irritable bowel syndrome, menstrual cramps, or other known causes or conditions you already have

  • Unusual, long-lasting (not related to a sudden injury, fibromyalgia, or other known causes or conditions you already have)

  • Unusual, fatigue, lack of energy (not related to depression, insomnia, thyroid dysfunction, or other known causes or conditions you already have)

  • For older people






I understand that attending and participating in this program increases my exposure (and those that are in direct contact with me on-site - 2 metres away for more than 15 minutes) to the risk of contracting community acquired COVID-19 (Coronavirus) infection. Acquiring such infection can lead to severe symptoms such as fever, chest pain, shortness of breath and further respiratory complications. Advanced disease can also lead to: prolonged hospitalization, intensive care admission, mechanical ventilation, and/or possible death.

Kadimah JCAMP will implement all Ministry of Health guidelines to reduce the risk of COVID-19 transmission but cannot fully eliminate this risk.
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