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Juror Service COVID-19 Pre-screening Questionnaire

  1. DEAR PROSPECTIVE JUROR

    As part of the court's measures to protect against the spread of the COVID-19 disease, we ask that you complete and submit this questionnaire before reporting for jury service.

  2. SYMPTOMS: check any that apply to YOU or A MEMBER OF YOUR HOUSEHOLD*







    IF YOU ARE EXPERIENCING ANY OF THE ABOVE SYMPTOMS, CONTACT [email protected] TO BE EXCUSED FROM SERVICE.

  3. 1. CONTACT HISTORY: check any that apply to YOU or A MEMBER OF YOUR HOUSEHOLD*

    IF ANY OF THE ABOVE APPLY, CONTACT JURY SERVICES [email protected] TO BE EXCUSED FROM SERVICE.

  4. 2.    COVID-19 RELATED EXCUSE OR POSTPONEMENT: Individuals who are over age 65 and individuals with serious underlying health conditions, such as high blood pressure, chronic lung disease, diabetes, obesity, asthma, and those whose immune system is compromised, such as by chemotherapy for cancer or other conditions requiring such therapy, are considered to be vulnerable populations and may request to postpone or be excused from jury service at this time. If you wish to be excused or request that your jury service be postponed, check the appropriate box below.

    IF YOU ARE REQUESTING TO BE EXCUSED OR YOUR SERVICE DATE BE RESCHEDULED DUE TO A COVID-19 RELATED REASON, CONTACT [email protected].

  5. 3.    FACE COVERINGS: Prospective jurors have the option to wear a face covering while they are in the courthouse. A disposable face mask will be provided upon request.

  6. COVID-19 SAFETY MEASURES
    • The judges and court staff are currently monitoring themselves prior to coming to work.
    • Judges or court staff who feel feverish or have measured temperatures above l00° F, or with new or worsening signs or symptoms of COVID-19 such as loss of taste or smell, cough, nausea or vomiting, headache, shortness of breath or difficulty breathing, diarrhea, chills, muscle pain or body aches, sore throat, fatigue, congestion or runny nose, or have knowingly had close contact with a person who is confirmed to have COVID-19 are not permitted to enter the building and are encouraged to seek medical advice.
    • Judges, court staff, and all other individuals have the option to wear face coverings while in the courtrooms. A disposable mask and/or face shield will be provided upon request.
    • Hand sanitizer dispensers have been placed throughout the court buildings.
    • Signage has been posted at the entrances of the court buildings. The signs have language asking individuals entering the court buildings if they are feeling feverish, have a cough, or shortness of breath to seek medical attention.
    • Staff who are screening individuals entering the courtrooms will be provided personal protective equipment, if desired.
    • Court building cleaning staff have been trained on proper cleaning techniques and provided appropriate personal protective equipment along with cleaning supplies shown to be effective with COVID-19.
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  8. This field is not part of the form submission.