1. Close Contact:
How often in the last 14 days have you ...
NOTE: For each question in this section, if you were wearing a properly fitted protective mask (e.g., KN95 or a N/P-95, N/P-99 or N/P-100 respirator mask) for all of these encounters, you may select "Never"
INDOORS: Been in unprotected close contact indoors with anybody outside of your household (i.e., been within 6 feet without you and/or them wearing a protective mask such as a KN-95 mask over their mouth and nose).
GROUP/INDOORS: Been in unprotected close indoor contact with a group of people outside of your household (i.e., been within 6 feet without you and/or them wearing a protective mask such as a KN-95 mask over their mouth or nose). This includes meetings, shared meals, restaurants, parties, carpooling, air travel or using public transportation.
OUTDOORS/NOT MOVING: Been within 1 foot for more than 15 cumulative minutes of people outdoors in a stationary environment (not moving around, such as outdoor dining) with anyone NOT wearing a protective mask over their mouth and nose.
SYMPTOMATIC ENCOUNTER: Had any encounter in which someone who was actively symptomatic and not properly wearing a mask over their mouth and nose.
At least once, over an extended period of time (e.g., on a flight)
How often in the last 14 days have you...
Touched your face without first washing or sanitizing hands.
3. COVID-19 Symptoms:
In the last 14 days, how many of the following symptoms has ANYONE in your household or bubble had:
Extreme fatigue (beyond your normal tiredness), nausea, vomiting, diarrhea or intestinal discomfort, shortness of breath or difficulty breathing, cough, sore throat, runny nose/congestion, elevated body temperature of 100.3 degrees (or 2 degrees above your normal body temperature, whatever that may be), concerning muscle aches or soreness.
Three or more
4. COVID-19 Status:
In the last 14 days, has anyone in your household OR the household(s) you are planning to visit tested positive for the virus that causes COVID-19, or been concerned anyone in your household or bubble may have been exposed to COVID-19.
Have you and your entire household been fully vaccinated for COVID-19, to include the required two week waiting period after receiving the full vaccination dose? (Note that we recommend you confirm vaccination status with ALL parties in advance of your visit).
5. Personal Health Risk
The CDC has identified a list of underlying medical conditions which can present increased risk of severe illness from COVID-19.
Go here to see the complete list from the CDC--->https://bit.ly/2WnYKug
Which answer below best describes the risk that you, anyone in your household or anyone you plan to visit may have of experiencing severe illness or complications from COVID-19 (or any airborne virus) due to underlying medical conditions?
Not at all
6. COVID-19 Community Hospitalization Rate
Visit your local Department of Public Health or the Johns Hopkins University Coronavirus Research Center website to confirm this.
See the CDC thresholds--->https://www.cdc.gov/coronavirus/2019-ncov/science/community-levels.htm)
What is the COVID-19 community hospitalization rate in the state/county where you presently are?
7. Your Attitude
Which response best represents your personal risk tolerance for becoming infected with COVID-19 (or any airborne virus)?
I am not worried. If I get it, I get it.
I am pretty careful. I wear a mask in public places but I don’t go overboard. I adopt public health guidelines to fit my lifestyle choices.
I am not taking any chances. I am strictly following or exceeding public health guidelines, without exception.
It's Almost Done!