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Specific Name of Location
*
example: Safeway, Pizza Hut, Mt Baker Beach, Mothers House
What area I was in
*
Algona
Auburn
Beaux Arts Village
Bellevue
Black Diamond
Bothell
Burien
Carnation
Clyde Hill
Covington
Des Moines
Duvall
Enumclaw
Federal Way
Hunts Point
Issaquah
Kenmore
Kent
Kirkland
Lake Forest Park
Maple Valley
Medina
Mercer Island
Milton
Newcastle
Normandy Park
North Bend
Pacific
Redmond
Renton
Sammamish
SeaTac
Seattle
Shoreline
Skykomish
Snoqualmie
Tukwila
Woodinville
Yarrow Point
Other
What area I was in
What Type of Activity was I engaged in
*
(examples: went shopping, went to a wedding, visited family or friends, went to a movie, etc...)
Where does this activity fit in my Social Atom?
*
Community Activity
Work/School
Loved Ones
Spiritual Activity
Original Family
Community Association
Friends and Acquaintances
Entertainment
Please check all that apply.
Description of what I did to protect myself from Coronavirus
*
Type of Location
*
airport
amusement park
aquarium
art gallery
atm
bakery
bank
bar
barber
beauty salon
bicycle store
bookstore
bowling alley
Bus
bus station
cafe
campground
car dealer
car rental
car repair
carwash
casino
cemetery
church
city hall
clothing store
convenience store
courthouse
dentist office
department store
doctors office
drugstore
electronics store
embassy
family members home
fire station
florist
friends home
funeral home
furniture store
gas station
grocery store
gym
hardware store
home goods store
hospital
insurance agency
jewelry store
laundry
lawyer
library
light rail station
liquor store
local government office
locksmith
lodging
mosque
movie theater
museum
night club
park
pet store
pharmacy
Plane
police station
post office
primary school
real_estate_agency
restaurant
rv park
school
shoe store
shopping mall
spa
stadium
storage
store
subway station
supermarket
synagogue
taxi, uber or Lift
theater
tourist attraction
train
train station
transit station
travel agency
university
veterinary
zoo
Other
Other
Safety Measures
*
Wore a Mask
Washed my Hands
Social Distanced
Used a Personal Air Purifier
Used At-home testing
Used Curbside Pickup
Used Delivery Service
Air Purifier
well ventilated
Other
Other
Do I think I was ever infected by the Coronavirus in the past?
*
Yes
No
If you are human, leave this field blank.
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