Self Health Assessment

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Connecticut Forest & Park Association (CFPA) volunteers and event participants must complete this self health assessment prior to participation in any CFPA Activity to minimize the risk of spreading COVID-19. First and foremost, CFPA cares about your safety and that of your fellow volunteers and participants, and it is with the interest of ensuring a safe and healthy experience that we ask that you carefully review this health assessment prior to any volunteer event or activity. At this time, filling out this form applies to anyone who wishes to participate in any CFPA Activity. To view the latest updates from the Governor's Executive Order No. 7111 concerning COVID-19, follow this link:

https://portal.ct.gov/Coronavirus/travel

Have you or a member of your household traveled internationally, or on a cruise, or to one of the states included in Governor Lamont's Executive Order No. 7III, in the last 14 days? *

Yes

In the last 14 days have you had close contact (< 2 meters/6 feet) for 10 consecutive minutes or more) with a person who has been diagnosed with or suspected of having COVID-19 (by testing or by a health care provider)? *

Yes

Do you have a fever equal to or greater than 100.4°F? *

Yes

Are you experiencing any of the following symptoms associated with COVID-19? Fever, chills, cough, shortness of breath, difficulty breathing, a new loss of taste or smell or diarrhea; OR Unexplained headache, tiredness, muscle pain, nasal congestion, runny nose or sore throat. *

Yes

Have you tested positive for COVID-19, with or without symptoms, in the last 14 days? *

Yes

If you answered YES to any of the above, we ask you to refrain from participating in any CFPA activity for 14 days. This 14 day period starts when: (1). The program participant or your household member arrived back in Connecticut from international travel, or a cruise or one of the states implicated by Governor Lamont's Executive Order No. 7III, (2). The program participant last had contact with the person diagnosed with or suspected of having COVID-19, (3). The program participant or an infected household member has gone 72 hours without a fever (3 full days of no fever without the use of medicine that reduces fevers) AND their other symptoms have improved (e.g. when their cough or shortness of breath has improved) AND at least 14 days have passed since the program participant or household member’s symptoms first appeared, (4). Program participant receives their test results indicating you have COVID-19 and have not shown any symptoms of COVID-19.

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms