Participant Wellness Check-in

JVS is now requiring all participants, staff, and visitors to complete the following wellness check-in survey each day prior to attending in-person programing. This is to safeguard the health and safety of our community, including by reducing the likelihood of “breakthrough infections” and protecting those in our community who are at increased risk for severe illness from COVID-19.

Your information provided in this wellness survey will be used to prevent and respond to the presence of COVID-19 at JVS and to comply with federal, local and public health guidelines. Your information will be maintained in accordance with our confidentiality protocols and in accordance with all applicable laws and public health regulations.

Full Name

Today's date

What program are you currently enrolled in at JVS?

In the last 10 days, have you been diagnosed with COVID-19 or had a test confirming you have the virus?

In the past 14 days, have you had “Close Contact” with someone who was diagnosed with COVID-19 or had a test confirming they have the virus while they were contagious? For COVID-19, a close contact is anyone who was within 6 feet of an infected person for a total of 15 minutes or more.

In the past 24 hours, including today, have you had one or more of these symptoms that is new or not explained by another condition?

- Fever (100.4 F, 38 C or greater), chills, repeated shaking/shivering

- Cough

- Sore throat

- Feeling unusually weak or fatigued

- Loss of taste or smell

- Muscle or body aches

- Headache

- Runny or congested nose

- Diarrhea

- Nausea or vomiting

Are you fully COVID vaccinated?

Please be informed that JVS has the ability to support you in accessing a healthcare provider. So please do not hesitate to email info@jvs.org and let us know you need access to a healthcare provider.