ATTESTATION of No COVID-19 Symptoms

Visitors and guests must complete this agreement prior to entering Buck campus.

Buck COVID-19 Protocol – updated November 15, 2021

Buck Institute has taken extensive precautions to limit the spread of COVID-19 on our campus and ensure compliance with the latest Public Health orders and Cal/OSHA standards.

In compliance with Marin County health orders and Cal/OSHA standards, all Visitors and Guests:

  • Are required to show proof of vaccination.
  • Are required to either take a COVID test prior to entering or wear a mask during their visit
  • May request an N95 to wear for their protection

Buck Institute is taking the following measures to ensure the health of all individuals:

  • Everyone entering the building is required to observe good hygiene and cough or sneeze into their elbows or a tissue.
  • Individuals are not to come to the Buck if they are sick.
  • Anyone with a new and unexplained cough, fever, or other symptoms of the COVID-19 virus as below should not enter the building.
  • Disinfecting break rooms, restrooms, common areas, and high contact surfaces has increased.
  • There are an increased number of hand sanitizer stations available, including inside and outside each campus entry point.
  • Soap and water are available to all individuals at all restrooms and selected hand washing stations.
  • Buck’s updated Mask Policy applies to any individual on campus and in the building.

Agreement

  • * Denotes a required field

  • In order to be at the Buck campus, you must verify you DO NOT have any of the following symptoms and the below statements are true:
    1. I do not currently have any of the following symptoms of COVID-19 infection:
      • Fever (≥37.8°C/100°F)
      • New onset cough
      • Shortness of breath or difficulty breathing
      • Headache
      • Nausea
      • Sore throat
      • Nasal congestion or runny nose (different from pre-existing allergies)
      • Loss of sense of smell or taste
      • Diarrhea
      • Conjunctivitis (pink eye)
      • Unexplained body aches
    2. I have not taken any medication to mask symptoms of fever and infection such as acetaminophen, ibuprofen, aspirin, or certain cough medications.
    3. I have not been diagnosed with COVID-19 within the previous 14 days.
    4. I have not been in contact with someone who has been diagnosed with COVID-19 within the previous 14 days.
    5. In the past 14 days, I have not been identified as a contact requiring self-monitoring for symptoms by Buck or by a public health agency as part of “contact tracing” related to someone diagnosed with COVID-19.
    6. I will wear a mask indoors or take a COVID test, in adherence with the Buck Institute’s COVID Guidelines, as posted in the building.
  • Please sign above by typing your name.
    Be sure to choose one of the certification options above.