UPDATED September 2021 Health Self-Screening Requirements
And At-Home Checklist for Employees, Volunteers, Parents, and Young People
All Employees, Volunteers, Parents, and Young People associated with a parish religious education or youth ministry
program will need to complete a health self-check by answering the questions listed below and taking their own
temperatures prior to entering the religious education or youth ministry program. This can be done anytime during
the day but must be done before attending. A parent or guardian is responsible for completing the daily screening on
behalf of their child(ren).
Below are the updated self-screening questions that employees, volunteers, parents, and young people are required to
answer on the day of the religious education/youth ministry prior to entering into the program.
a) If you are not yet fully vaccinated, have you been in close or proximate contact in the past 10 days with anyone
who has tested positive through a diagnostic test for COVID-19 or who has or had symptoms of COVID-19?
b) Are you waiting for the results of or have you tested positive through a diagnostic test for COVID-19 in the past
c) Do you have at least one of the following symptoms: cough, shortness of breath, difficulty breathing, new loss
of taste or smell?
d) Do you have at least any of the following symptoms: fever (over 100.0°F or subjective), chills, rigors (shivers),
muscle aches, headache, sore throat, nausea or vomiting, diarrhea, fatigue, congestion, runny nose?
If the answers are NO to all of the following questions, individuals may enter the program. If you answer YES
to any question above you or your young person may not attend the religious education or youth ministry
program that week. Please contact a medical professional and your Director/Coordinator of Religious
Education or Youth Ministry Coordinator. (Please note temperatures will still be taken onsite.) For young
people with chronic illness, only new symptoms or symptoms worse than baseline should be used to fulfill
symptom-based exclusion criteria.
Depending upon the answers to the screening questions, you or your young person may need to receive medical
clearance and a negative COVID test to return to the program. If you or your young person is sick with a common cold
or another ailment not related to COVID-19 and has an approved alternative diagnosis, they should stay home until
symptoms subside and you or your young person is fever-free without the aid of a temperature reducing drug.
International & Domestic Travel Vaccinated & Unvaccinated Follow CDC Guidance https://www.cdc.gov/coronavirus/2019-
By signing below and submitting this form, you acknowledge that you read the above will comply with all
requirements. You acknowledge that you will complete the attached checklist on the day of religious education/youth
ministry for yourself or your young person for the 2021-2022 Religious Education/Youth Ministry year.
Signature of Parent or Guardian Date:
Young Person’s Name Grade:
PLEASE KEEP THIS PAGE AT HOME - DO NOT RETURN
FOLLOW THESE GUIDELINES TO DETERMINE IF YOUR CHILD IS ABLE TO ATTEND RELIGIOUS
EDUCATION OR YOUTH MINISTRY
Parents should take their child’s temperature on the day of religious education/youth ministry. If your child has
a fever of 100.0 or over, your child should be kept home. A fever is a key symptom of COVID-19. You should ask
your child if he/she has any other symptoms of COVID-19 (see below). If your child complains of these
symptoms or has a fever, or you answer YES to a question in section two, please keep them home, call your
child’s doctor, and contact the parish to report your child’s absence. If your child is sick with a common cold
or another ailment, your child should stay home until symptoms subside and they are fever-free. Those
with symptoms must be tested for COVID-19 before returning to religious education or youth ministry.
SECTION 1: Symptoms
Consider all that apply:
_____ fever or chills – Is fever 100.0°F or higher?
_____ sore throat, congestion, or runny nose?
_____ new or worsening cough that causes difficulty breathing? (If your child has chronic allergies or an
asthmatic cough, is there a change in their cough from baseline?)
_____ diarrhea, nausea, or vomiting?
_____ onset of severe headache, especially with a fever?
_____ fatigue, muscle or body aches; loss of taste or smell?
People with COVID-19 have had a wide range of symptoms reported – ranging from mild symptoms to severe
illness. Symptoms may appear 2-14 days after exposure to the virus. People with these symptoms may have
COVID-19. This list does not include all possible symptoms. CDC will continue to update this list as they learn
more about COVID-19. https://www.cdc.gov.
SECTION 2: Close Contact/Positive Test
Have you/your child had close contact (within 6 feet of an infected person for at least 15
minutes) with a person confirmed positive in the past 10 days?
Are you/your child waiting for the results of or tested positive for COVID-19?
International & Domestic Travel
Vaccinated & Unvaccinated Follow CDC Guidance