COVID-19 Self-Attestation Form

Before leaving your home to join an event, activity, or outing with the San Juan Islands Conservation District (SJICD), all participants are required to complete this online attestation before each event, activity, or outing.

Within the last 14 days, have you experienced any of the following symptoms?

  • A new fever (100.4 F or higher) or a sense of having a fever?

  • A new cough that you cannot attribute to another health condition?

  • New shortness of breath that you cannot attribute to another health condition?

  • A new sore throat that you cannot attribute to another health condition?

  • New muscle pain that you cannot attribute to another health condition or that may have been caused by a specific activity, such as physical exercise?

  • New gastrointestinal symptoms, such as nausea, vomiting or diarrhea that you cannot attribute to another health condition?

  • New respiratory symptoms, such as a runny nose, that you cannot attribute to another health condition?

  • New chills that you cannot attribute to another health condition?

  • New loss of taste or smell that you cannot attribute to another health condition?

  • A new headache that you cannot attribute to another health condition or emotional reason?

If you are sick or have one or more of the above symptoms before or during an SJICD event, outing, or activity:

  1. You must stay home.

  2. Leave the location and report your symptoms to SJICD staff.

  3. Contact your health care provider for medical guidance.

  4. Follow the guidance from Washington State Department of Health’s FAQ: “What do I do if I have COVID-19 symptoms?”

If you received positive test results for a COVID-19 infection within the past 14 days, stay home and follow the guidance in “What to do if you have confirmed or suspected COVID-19”.

If within the past 14 days you were in close contact with a person who has a COVID-19 infection, stay home and follow the guidance in the “What to do if you were potentially exposed to someone with COVID-19“.

Close contact includes being within approximately 6 feet of a person with confirmed COVID-19 for more than a few minutes, living with a person who has COVID-19 or having direct contact with infectious secretions of a COVID-19 case (e.g., being coughed on, kissing, sharing utensils).

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