COVID Parishioner Reporting Form

This form is intended to be used if reporting a parishioner, who has been in contact with our parish building in any capacity, who has tested positive for COVID-19.

All questions are required.

Your Name

Your Email

Parishioner Name (First and Last):

Date of Birth of Parishioner:

Name, relationship to parishioner, and phone number for person who called:

Current Condition and location of parishioner:

Date of onset of symptoms:

Date of positive COVID-19 test:

Date and time parishioner was in building:

Reason for Attendance:

Any additional information you feel we should know? (optional)