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COVID-19 SELF DECLARATION

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Abu Dhabi Desert Challenge 2021 Covid-19 Self Declaration
This questionnaire is required to be filled in by any attendee participating in the Abu Dhabi Desert Challenge 2021

All information provided in this questionnaire are for internal screening purposes only and will remain confidential. Information will only be shared if an attendee is identified as an ‘At Risk Attendee’ and only with their express written permission.
By entering my personal information, I consent to receive email communications from the survey author’s organization based on the information collected.
- First Name*
- Last Name*
- Email*
How old are you?*
- Under 11
- Between 11 – 17
- Between 18 – 64
- 65 or older
Please specify your role during the event*
- Competitor
- Official
- Organizer / Team Member
- Media
- Service Crew
From where have you traveled to attend the Abu Dhabi Desert Challenge? (if arriving from outside of UAE)*
When did you arrive in the UAE? (if traveling from other country)*
In the last 10 days, have you been tested for COVID-19?*
- I was tested and my result was positive for COVID-19
- I was tested and my result was negative for COVID-19
- I was tested but I have not yet received my test results
- I have not been tested in the last 10 days
Have you recently started experiencing any of these symptoms?*
- Fever or chills
- Mild or moderate difficulty breathing
- New or worsening cough
- Sudden loss of taste or smell
- Sore throat
- Vomiting or diarrhea
- Severe, unexplained fatigue or aching throughout the body
- None of the above
Select all that apply
Do any of these apply to you?*
- Obesity
- Smoking or vaping
- Pregnancy
- Diabetes
- High blood pressure (Hypotension)
- Chronic kidney diseases or liver diseases
- Chronic lung disease, such as moderate to severe asthma, COPD (chronic obstructive pulmonary disease), cystic fibrosis, or pulmonary fibrosis
- Serious heart condition, such as heart failure, prior heart attack, or cardiomyopathy
- Weakened immune system from HIV, cancer treatment, use of medicines causing immune supression, or other factors (please specify below)
- Stroke, dementia, or other cerebrovascular disease or neurologic condition
- Sickle cell disease, thalassemia, or other blood disorder (please specify below)
- None of the above
Select all that apply
In the last 10 days, did any of these apply to you?*
- I lived with someone who has COVID-19
- I looked after somebody who had COVID-19
- For at least 15 minutes, I was within 6 feet of someone who has COVID-19
- I might have been exposed to COVID-19
- I’ve had no potential exposure fo COVID-19
Select all that apply
In the last 10 days, did you visit a healthcare facility?*
- I visited a healthcare facility in the last 14 days
- I did not visit a healthcare facility in the last 14 days
This includes a clinic, hospital, emergency room, other medical setting, or long-term care facility.

DECLARATION*
I CONFIRM THAT THE SUBMITTED INFORMATION IS ACCURATE TO THE BEST OF MY KNOWLEDGE
Continue to observe the three pillars of COVID-19 infection control:

Keep Social Distance (2m, wherever possible)

Wear a face mask at all times

Wash hands regularly or use hand-sanitizer

By submitting this document, you agree that you have read and understood the Covid-19 Protocols implemented by the Abu Dhabi Desert Challenge organizers as well as the provisions of the FIA International Sporting Code Appendix S – Covid-19 Code of Conduct available on www.fia.com.

For further information, please refer to:

EMSO Return to Race

By submitting this questionnaire, I hereby release and agree to hold the Abu Dhabi Desert Challenge Organizers
and FIA harmless from, and waive on behalf of myself, my heirs, and any personal representatives, any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of the Abu Dhabi Desert Challange Organizers and FIA, or that may otherwise arise in any way in connection with any services received from the Abu Dhabi Desert Challenge Organizers and FIA.
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Documents Verified
- Select All
- ID Verified
- AlHosn App Verified
- PCR Test Verified

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