COVID-19 Self-Reporting Form

COVID-19 Self-Reporting Form

In an effort to keep everyone safe, Wesley UMC provides this COVID-19 Self-Reporting Form. If you have tested positive for Coronavirus, please let the Wesley Staff know, so that we may provide care for you and your family. Please also work with your healthcare provider and/or McLean County Public Health, to keep yourself and others as safe and healthy as possible.
If you have tested positive and also participated in a recent Wesley event, please let the Wesley Staff know, so that we may notify others who may have been exposed. This is an act of love and care for others, and in no way stigmatizes or judges any person who may have been an unknowing carrier at the time of participation. We trust that all persons participating in Wesley events have self-screened before coming to an event (see Phase Four COVID-19 Policy – https://www.wesley-umc.com/wp-content/uploads/2020/07/PHASE-FOUR-Doc.pdf), and would not knowingly attend while experiencing symptoms of COVID-19.
Please complete and submit the following form to help Wesley UMC keep all our participants informed and safe. Know that your personal identity and information will not be shared without your permission, but that appropriate information-sharing and contact tracing prevents further transmission and saves lives.
Information shared on this Self-Report form will be used ONLY to notify participants at the same event as you, of a possible exposure. Your information will NOT be shared beyond this.
In case of an “outbreak” (3 or more infections traced to the same Wesley event), the congregation at-large may receive an email from the Directing Pastor, naming the event and date at which transmission may have occurred. Your name will NOT be shared unless you explicitly permit us to do so.

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