COVID-19 Health Check Form

Pursuant to Sections 30, 31, 32, and 39(3) and (6) of the Public Health Act, SCB 2008, this form must be completed be each person attending a funeral at any cemetery operated by the Schara Tzedeck Cemetery Board.

This form must be completed in advance of arrival at the cemetery.

No person may attend a funeral service unless they have completed this form by answering all questions truthfully. (It is an offense under Section 99 of the Public Health Act, SCB 2008 to provide false information on this form.)

The information collected will be retained by us for 30 days after which it will be destroyed. This information will be provided to the Public Health Officer on their request pursuant to regulations and for the purpose of contact tracing.