This form is used to safeguard everyone involved at 2022 State Assembly. If you are either diagnosed with Coronavirus or experiencing Coronavirus symptoms, please provide us with your contact information. Please also list out the people who you regularly contact or have been in contact with during the last 14-days period for each. If you have been in other public or crowded locations during this period, please specify and also list people that you have contacted. If you are not experiencing symptoms, this form is still used.