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Health Screening Questionnaire

We look forward to seeing you back at Bais Abe! Please be in touch if you have any questions about the reopening process, or if you need help filling out the form. You can read Rabbi Silberstein's letter to the community and reopening protocols here.

Screening Questions

  • Have you had a diagnosis of or suspected diagnosis of COVID-19 in the past 14 days?
  • Have you been exposed to confirmed or suspected COVID-19 in the past 14 days?
  • Have you had any of the following symptoms in the past 14 days (not due to a chronic preexisting condition)?
    • Fever(100.4 F or higher), chills or shaking
    • Cough, shortness of breath or difficulty breathing
    • Headache
    • sore throat
    • muscle aches
    • diarrhea, nausea, vomiting or abdominal pain
    • runny nose
    • new loss of sense of taste or smell (for adults)
    • “COVID toe” (red or purple toe swelling


Sat, September 26 2020 8 Tishrei 5781