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Temple Sinai Member and Guest Screening Form

This screening form must be completed on the same day as your visit.

Please note: Upon entry to Temple Sinai, you will be required to provide proof of vaccination, either a paper or an electronic vaccination receipt.

To read Temple Sinai's Covid-19 Vaccination Policy, please visit

Immunization Screening

If No, please list the family members name(s) and age(s).

Immunization Screening

If No, please list the family members name(s) and age(s).

Personal Information

Time of your visit

Covid-19 Screening Questions
Are you experiencing any of these symptoms, new or worsening, not related to other known causes or conditions you already have and not related to getting a COVID-19 vaccine in the last 48 hours?
  • Fever (37.8°C or higher) and/or chills
  • Cough or barking cough
  • Shortness of breath
  • Decrease or loss of smell or taste
  • Muscle aches that are unusual or long lasting
  • Extreme tiredness that is unusual

The personal information contained on this form is collected and used under the authority of Temple Sinai Congregation of Toronto and in accordance with the Freedom of Information and Protection of Privacy Act to screen individuals for Covid-19 prior to accessing Temple Sinai property.

If you begin to experience any Covid-related symptoms prior to your arrival, please do not attend AND let us know, so we can follow up on you. Email:
Thank You
Thank you for your interest in joining us at Sinai. At this time, your responses indicate that you are unable to attend in person. If you have any questions, please contact
In the meantime, please visit us online at to attend one of our many virtual services or programs.
Note: This screening tool is based on recommendations by the Office of the Chief Medical Officer of Health, Province of Ontario, October 1, 2021.