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2. INITIALS & JUROR REPORTING #:*
   (SEE NUMBER ON YELLOW SUMMONS)
4. COVID-19 Initial Screening Questionnaire for Prospective Jurors
6. The virus that causes novel coronavirus disease (COVID-19) is primarily spread from person to person. Courtrooms are considered medium exposure risk environments. To help protect the health of Idahoans, an initial screening to determine juror eligibility to serve should be conducted. Answering the medical questions will be kept confidential.
8. 1. Are you 65 years of age or older?

   1. Yes
   2. No
9. A. lf yes, would you like your service to be postponed for one year?

   1. Yes
   2. No
11. 2. Do you have any medical conditions that put you at high risk for COVID-19?

    1. Yes
    2. No

    Examples are chronic kidney disease, chronic obstructive pulmonary disease (COPD), immunocompromised (weakened immune system) from solid organ transplant, severe obesity (body mass index [BMI] of 30 or higher), serious heart condition (such as heart failure, coronary artery disease, or cardiomyopathies), sickle cell disease, or type 2 diabetes mellitus. [Note: COVID-19 is a new disease and this list is subject to change. Changes will be posted to https://www.cdc.gov/coronavirus/201--ncov/need-extra-precautions/people-with-medicalconditions. html.]
12. A. lf yes, would you like your service to be postponed for one year?

    1. Yes
    2. No
14. 3. Are you a health care worker directly involved with the diagnosis, treatment, management, or care of patients who have or are suspected of having COVID-19?

    1. Yes
    2. No

    [Note: Healthcare workers include physicians, nurses, nursing assistants, emergency medical personnel, dental professionals and students, medical and nursing students, laboratory technicians, phlebotomists, pharmacists, therapists, hospital volunteers, and some administrative staff and environmental services staff.]
15. A. lf yes, would you like your service to be postponed for one year?

    1. Yes
    2. No
17. Further instruction will be sent as the trial date approaches. If you have questions or concerns email communication is preferred.
    JURY@BLAINECOUNTY.ORG
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19. 1. Receive an email copy of this form.
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