Zenkaikon 2023 Covid Self-Reporting Form
In the event that an attendee tests positive for COVID-19 during or after Zenkaikon 2023, Zenkaikon hopes to help other community members determine if they might have had close contact with that attendee.

We will share self-reported information with the community, including panel dates and times where a positive attendee was present.

We will not share your personal information, but we may use it to follow up if we have questions.

Thank you for self-reporting and for taking steps to keep all of us (including yourself) safe and healthy!

If you have further questions or information that you'd like to share, please contact us at covid@zenkaikon.org .
Email *
First and Last Name *
This will help us confirm you actually were in attendance.
E-mail address? *
May be used for any follow up questions
Cell Phone Number
Not required, but this may be used for any follow up questions, especially if a time-sensitive answer is needed.
Are you vaccinated? *
Did you get your booster? *
Did you download the PA Covid Tracking App? *
If yes--please remember to report your positive test result to the app so it can do its thing!
What date were you tested? *
This should be the date of the test itself. E.g. if you took a test on Monday 1/21, but didn't get the results until Wednesday 1/12, please put Monday 1/10 here, and Wednesday 1/12 below.
MM
/
DD
/
YYYY
What date did you get a positive result? *
This should be the date that you learned of the results. E.g. if you took a test on Monday 1/10, but didn't get the results until Wednesday 1/12, please put Monday 1/10 above, and Wednesday 1/12 here.
MM
/
DD
/
YYYY
What type of test was it? *
Are you experiencing symptoms?
Clear selection
If yes, what date did your symptoms start?
MM
/
DD
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YYYY
If yes, please describe symptoms.
Is there any other information about your testing and symptoms that we should know? (e.g. timeline, multiple tests, etc.)
Were you wearing your mask?
Clear selection
Zenkaikon Programming Attended - Thursday *
Please check any areas or rooms you were in for more than 15 minutes.
Required
Zenkaikon Programming Attended - Friday *
Please check any areas or rooms you were in for more than 15 minutes.
Required
Zenkaikon Programming Attended - Saturday *
Please check any areas or rooms you were in for more than 15 minutes.
Required
Zenkaikon Programming Attended - Sunday *
Zenkaikon Programming:  Where in the room where you usually seated *
Zenkaikon Artist/Dealer Hall:  If you visited, did you spend more than 15 minutes in any particular area or booth?
If there any event where you spent more than 15 minutes in line waiting to be admitted, please name it.
Please provide any other more specific details about the above information that you think would be helpful to inform other attendees who might be exposed?
What housing or hotel are you staying in?
Did you attend any room parties, enter any restaurants, or any other area outside of your hotel space without a mask for more than 15 minutes in the indoor setting? *
What day or days did these occur? *
Required
A copy of your responses will be emailed to the address you provided.
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