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Prior to attending the WSBA Board of Governor's meeting or function, please take this self screening questionnaire.  Please respond to each of the following questions truthfully and to the best of your knowledge. Your participation is important to help us take precautionary measures to protect you and other participants. 

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* 1. IS YOUR TEMPERATURE OVER 100.4 DEGREES? 

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* 2. DO YOU HAVE SYMPTOMS YOURSELF? Have you experienced any of the following [new or unexpected] symptoms in the past 48 hours?

-fever or chills 
- new loss of taste or smell 
- cough 
- sore throat 
- shortness of breath or difficulty breathing 
- congestion or runny nose 
- fatigue 
- nausea or vomiting 
- muscle or body aches  
- diarrhea 
-  headache 
*If you develop symptoms during the meeting/event, you must leave the meeting/event 

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* 3. HAVE YOU BEEN IN CONTACT WITH ANYONE CONFIRMED/SYMPTOMATIC WITH COVID? Within the past 14 days: 
a) Have you been in close physical contact (6 feet or closer for a cumulative total of 
    15 minutes) 
     OR 
b) Have you provided care at home to someone who is sick with COVID-19 
     OR 
c) Have you had direct physical contact with the person (hugged or kissed them) 
    OR 
d) Have you shared eating or drinking utensils 
    OR 
e) Have you had direct contact with fluids (being coughed on, sneezed on) from: 
     i) Anyone who is known to have laboratory-confirmed COVID-19? 
         OR 
    ii) Anyone who has any symptoms consistent with COVID-19?

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* 4. HAVE YOU BEEN ASKED TO MONITOR, ISOLATE, OR QUARANTINE DUE TO COVID? 
Are you monitoring, isolating, or quarantining because you may have been exposed to a person with COVID-19 or are worried that you may be sick with COVID-19? 

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* 5. DO YOU HAVE A PENDING OR POSITIVE COVID TEST? Are you currently waiting on the results of a COVID-19 test? Have you had a positive COVID-19 test for active virus in the past 10 days? 

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* 6. HAVE YOU TRAVELED OUTSIDE THE COUNTRY OVER THE LAST 14 DAYS?  If YES, you cannot enter the meeting as we are following the CDC guidelines below.

After travel information for unvaccinated people:

Get tested with a viral test 3-5 days after travel AND stay home and self-quarantine for a full 7 days after travel.Even if you test negative, stay home and self-quarantine for the full 7 days.
If your test is positive, isolate yourself to protect others from getting infected.
If you don’t get tested, stay home and self-quarantine for 10 days after travel.
Avoid being around people who are at increased risk for severe illness for 14 days, whether you get tested or not.
Self-monitor for COVID-19 symptoms; isolate and get tested if you develop symptoms.
Follow all state and local recommendations or requirements.
https://www.cdc.gov/coronavirus/2019-ncov/travelers/international-travel-during-covid19.html

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* 7. If you answered yes to any of the questions you have failed the questionnaire. Do not come to the meeting/event. If you answered no to all of the questions you have passed the questionnaire. You are clear to come to the meeting/event. Did you pass or fail this self screening questionnaire?

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* 8. I hereby acknowledge that the responses provided above are true and accurate to the best of my knowledge. Type your first and last name to affirm. 

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* 9. Phone number

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* 10. Email Address

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