Common use of Responsibility for Health Screening Clause in Contracts

Responsibility for Health Screening. By execution of this Statement, I affirm that my presence at the Parish or participation in Faith Formation activities on any day constitutes an affirmative representation on my part that that I have performed the health screening below and affirm that the responses to all questions are NO. SCREENING QUESTIONS “ YES or NO, I do not have any of the following:” • A fever of 100.4°F (38°C) or higher or a sense of having a fever during the past 72 hours • New or unexpected cough that cannot be attributed to another health condition • New shortness of breath or difficulty breathing that cannot be attributed to another health condition • New chills that cannot be attributed to another health condition • A new sore throat that cannot be attributed to another health condition • New muscle aches that cannot be attributed to another health condition or specific activity (such as physical exercise) • New loss of taste or smell • Nausea, vomiting or diarrhea • Currently living with a person who has exhibited symptoms of COVID-19 or is currently under quarantine due to close contact with a person suspected or confirmed to have COVID-19 “ YES or NO, in the past 14 days, I have not done any of the following:” • Cared for or had other close contact with a person suspected or confirmed to have COVID-19 • Travelled internationally I understand that on any day when I or anyone in my household has any of the above symptoms or situations, I am not permitted to participate in Faith Formation activities.

Responsibility for Health Screening. By execution of this Statement, I affirm that my presence at the Parish or participation in Faith Formation activities on any day constitutes an affirmative representation on my part that that I have performed the health screening below and affirm that the responses to all questions are NO. SCREENING QUESTIONS “ “YES or NO, I do not have any of the following:” • A fever of 100.4°F (38°C) or higher or a sense of having a fever during the past 72 hours • New or unexpected cough that cannot be attributed to another health condition • New shortness of breath or difficulty breathing that cannot be attributed to another health condition • New chills that cannot be attributed to another health condition • A new sore throat that cannot be attributed to another health condition • New muscle aches that cannot be attributed to another health condition or specific activity (such as physical exercise) • New loss of taste or smell • Nausea, vomiting or diarrhea • Currently living with a person who has exhibited symptoms of COVID-19 or is currently under quarantine due to close contact with a person suspected or confirmed to have COVID-19 “ “YES or NO, in the past 14 days, I have not done any of the following:” • Cared for or had other close contact with a person suspected or confirmed to have COVID-19 • Travelled internationally I understand that on any day when I or anyone in my household has any of the above symptoms or situations, I am not permitted to participate in Faith Formation activities.

Responsibility for Health Screening. By execution of this Statement, I affirm that my or my child(xxx)’s presence at the named Parish or participation in Faith Formation activities on any day constitutes an affirmative representation on my part that that I I/we have performed the required health screening below and affirm that the responses to all questions are NO. SCREENING QUESTIONS “ YES or NO, neither I do not nor my child(xxx) have any of the following:” • A fever of 100.4°F F. (38°C.) or higher or a sense of having a fever during the past 72 hours • New or unexpected cough that cannot be attributed to another health condition • New shortness of breath or difficulty breathing that cannot be attributed to another health condition • New chills that cannot be attributed to another health condition • A new sore throat that cannot be attributed to another health condition • New muscle aches that cannot be attributed to another health condition or specific activity (such as physical exercise) • New loss of taste or smell • Nausea, vomiting or diarrhea • Currently living with a person who has exhibited symptoms of COVID-19 or is currently under quarantine due to close contact with a person suspected or confirmed to have COVID-19 “ YES or NO, in the past 14 days, neither I nor my child(xxx) have not done any of the following:” • Cared for or had other close contact with a person suspected or confirmed to have COVID-19 • Travelled internationally I understand that on any day when I or anyone in my our household has answers YES to any of the above symptoms or situationsrequired health screening questions above, I am and/or my child(ren) are not permitted to participate in Faith Formation in-person Youth Ministry activities.

Responsibility for Health Screening. By execution of this Statement, I affirm that my presence at the Parish or participation in Faith Formation activities a Catholic Charities, Diocese of Arlington program site, on any day constitutes an affirmative representation on my part that that I have performed the required health screening below and affirm that the responses to all questions are NO. SCREENING QUESTIONS “ YES or NO, I do not have any of the following:” • A fever of 100.4°F F. (38°C.) or higher or a sense of having a fever during the past 72 hours • New or unexpected cough that cannot be attributed to another health condition • New shortness of breath or difficulty breathing that cannot be attributed to another health condition • New chills that cannot be attributed to another health condition • A new sore throat that cannot be attributed to another health condition • New muscle aches that cannot be attributed to another health condition or specific activity (such as physical exercise) • New loss of taste or smell • Nausea, vomiting or diarrhea • Currently living with a person who has exhibited symptoms of COVID-19 or is currently under quarantine due to close contact with a person suspected or confirmed to have COVID-19 “ YES or NO, in the past 14 days, I have not done any of the following:” • Cared for or had other close contact with a person suspected or confirmed to have COVID-19 • Travelled internationally or traveled to a highly impacted area within the United States • Undergone testing for COVID-19 I understand that on any day when I or anyone in my household has answer YES to any of the above symptoms or situationsrequired health screening questions above, I am not permitted to participate in Faith Formation activitiesin-person volunteering at a program site.

Responsibility for Health Screening. By execution of this Statement, I affirm that my or my child(xxx)’s presence at the named Parish or participation in Faith Formation activities on any day constitutes an affirmative representation on my part that that I I/we have performed the required health screening below and affirm that the responses to all questions are NO. SCREENING QUESTIONS “ “YES or NO, neither I do not nor my child(xxx) have any of the following:” • A fever of 100.4°F F. (38°C.) or higher or a sense of having a fever during the past 72 hours • New or unexpected cough that cannot be attributed to another health condition • New shortness of breath or difficulty breathing that cannot be attributed to another health condition • New chills that cannot be attributed to another health condition • A new sore throat that cannot be attributed to another health condition • New muscle aches that cannot be attributed to another health condition or specific activity (such as physical exercise) • New loss of taste or smell • Nausea, vomiting or diarrhea • Currently living with a person who has exhibited symptoms of COVID-19 or is currently under quarantine due to close contact with a person suspected or confirmed to have COVID-19 “ “YES or NO, in the past 14 days, neither I nor my child(xxx) have not done any of the following:” • Cared for or had other close contact with a person suspected or confirmed to have COVID-19 • Travelled internationally I understand that on any day when I or anyone in my our household has answers YES to any of the above symptoms or situationsrequired health screening questions above, I am and/or my child(ren) are not permitted to participate in Faith Formation in-person Youth Ministry activities.

Responsibility for Health Screening. By execution of this Statement, I affirm that my presence at the Parish or participation in Faith Formation Youth Ministry activities on any day constitutes an affirmative representation on my part that that I have performed the health screening below and affirm that the responses to all questions are NO. SCREENING QUESTIONS “ “YES or NO, I do not have any of the following:” • A fever of 100.4°F (38°C) or higher or a sense of having a fever during the past 72 hours • New or unexpected cough that cannot be attributed to another health condition • New shortness of breath or difficulty breathing that cannot be attributed to another health condition • New chills that cannot be attributed to another health condition • A new sore throat that cannot be attributed to another health condition • New muscle aches that cannot be attributed to another health condition or specific activity (such as physical exercise) • New loss of taste or smell • Nausea, vomiting or diarrhea • Currently living with a person who has exhibited symptoms of COVID-19 or is currently under quarantine due to close contact with a person suspected or confirmed to have COVID-19 “ “YES or NO, in the past 14 days, I have not done any of the following:” • Cared for or had other close contact with a person suspected or confirmed to have COVID-19 • Travelled internationally I understand that on any day when I or anyone in my household has any of the above symptoms or situations, I am not permitted to participate in Faith Formation Youth Ministry activities.

Responsibility for Health Screening. By execution of this Statement, I affirm that my or my child(xxx)’s presence at the Parish or participation in Faith Formation activities School on any day constitutes an affirmative representation on my part that that I I/we have performed the required health screening below and affirm that the responses to all questions are NO. SCREENING QUESTIONS “ YES or NO, neither I do not nor my child(xxx) have any of the following:” • A fever of 100.4°F F. (38°C.) or higher or a sense of having a fever during the past 72 hours • New or unexpected cough that cannot be attributed to another health condition • New shortness of breath or difficulty breathing that cannot be attributed to another health condition • New chills that cannot be attributed to another health condition • A new sore throat that cannot be attributed to another health condition • New muscle aches that cannot be attributed to another health condition or specific activity (such as physical exercise) • New loss of taste or smell • Nausea, vomiting or diarrhea • Currently living with a person who has exhibited symptoms of COVID-19 or is currently under quarantine due to close contact with a person suspected or confirmed to have COVID-19 “ YES or NO, in the past 14 days, neither I nor my child(xxx) have not done any of the following:” • Cared for or had other close contact with a person suspected or confirmed to have COVID-19 • Travelled internationally I understand that on any day when I or anyone in my our household has answers YES to any of the above symptoms or situationsrequired health screening questions above, I am and/or my child(ren) are not permitted to participate in Faith Formation in-person School activities.

Responsibility for Health Screening. By execution of this Statement, I affirm that my presence at the Parish or participation in Faith Formation activities a Catholic Charities, Diocese of Arlington program site, on any day constitutes an affirmative representation on my part that that I have performed the required health screening below and affirm that the responses to all questions are NO. SCREENING QUESTIONS “ “YES or NO, I do not have any of the following:” • A fever of 100.4°F F. (38°C.) or higher or a sense of having a fever during the past 72 hours • New or unexpected cough that cannot be attributed to another health condition • New shortness of breath or difficulty breathing that cannot be attributed to another health condition • New chills that cannot be attributed to another health condition • A new sore throat that cannot be attributed to another health condition • New muscle aches that cannot be attributed to another health condition or specific activity (such as physical exercise) • New loss of taste or smell • Nausea, vomiting or diarrhea • Currently living with a person who has exhibited symptoms of COVID-19 or is currently under quarantine due to close contact with a person suspected or confirmed to have COVID-19 “ “YES or NO, in the past 14 days, I have not done any of the following:” • Cared for or had other close contact with a person suspected or confirmed to have COVID-19 • Travelled internationally or traveled to a highly impacted area within the United States • Undergone testing for COVID-19 I understand that on any day when I or anyone in my household has answer YES to any of the above symptoms or situationsrequired health screening questions above, I am not permitted to participate in Faith Formation activitiesin-person volunteering at a program site.

Responsibility for Health Screening. By execution of this Statement, I affirm that my presence at the Parish or participation in Faith Formation Youth Ministry activities on any day constitutes an affirmative representation on my part that that I have performed the health screening below and affirm that the responses to all questions are NO. SCREENING QUESTIONS “ YES or NO, I do not have any of the following:” • A fever of 100.4°F (38°C) or higher or a sense of having a fever during the past 72 hours • New or unexpected cough that cannot be attributed to another health condition • New shortness of breath or difficulty breathing that cannot be attributed to another health condition • New chills that cannot be attributed to another health condition • A new sore throat that cannot be attributed to another health condition • New muscle aches that cannot be attributed to another health condition or specific activity (such as physical exercise) • New loss of taste or smell • Nausea, vomiting or diarrhea • Currently living with a person who has exhibited symptoms of COVID-19 or is currently under quarantine due to close contact with a person suspected or confirmed to have COVID-19 “ YES or NO, in the past 14 days, I have not done any of the following:” • Cared for or had other close contact with a person suspected or confirmed to have COVID-19 • Travelled internationally I understand that on any day when I or anyone in my household has any of the above symptoms or situations, I am not permitted to participate in Faith Formation Youth Ministry activities.