Phase Finder WA / Encuentra Tu Fase

There is a new version of this form. Please go to

FindYourPhaseWA.org.

Currently, this tool will only determine if you are eligible for the vaccine right now as the initial part of Phase 1. In the coming weeks as plans for future phases are confirmed, this tool will allow people to determine into which future phase they fall. Please check back.

Before you begin, there are a few things for some people to know:

If you are pregnant, you're welcome to complete this form, but please speak with your health care provider about your vaccination options.
This tool does not apply to anyone living in Indian Country or within tribal jurisdictions.
The Pfizer vaccine is authorized for people ages 16+ and the Moderna vaccine is authorized for people ages 18+.

How old are you?* This field is required.

age eligible over 16? (hidden)

YESNO

In what ZIP code is your home located?Enter 5-digit ZIP code; for example, 00544 or 94305

What county do you live in?This information is being collected to help determine where COVID-19 vaccine may be needed. It is not currently used for determining eligibility and is not required.

Select all of the following statements that apply to you:

I have active cancer.

I have chronic kidney disease.

I have chronic obstructive pulmonary disease.

I have a heart condition such as heart failure, coronary artery disease, or cardiomyopathies.

I am immunocompromised from a solid organ transplant.

I am obese (Body Mass Index (BMI) of 30 or higher).

I have sickle cell disease.

I have Type 2 diabetes.

I am a current or former smoker.

None of these apply to me.

Do you live in a community-based, congregate living setting (for example, a long-term care facility, adult family home, or residential care community) where most individuals over 65 years of age are receiving care, supervision or assistance?* This field is required.

YESNO

Do you work in a health care setting?* This field is required.

YESNO

Select all the following statements that apply to you:* This field is required.

I administer COVID-19 testing or I handle COVID-19 specimens.

I administer COVID-19 vaccine or have patient contact in a COVID-19 vaccination site.

I work at a community-based, congregate living facility (for example, a long-term care facility, adult family home, or residential care community) where people over 65 years old receive care, supervision, or assistance.

I am a professional careprovider to someone who is at higher risk of severe outcomes if infected with COVID-19 (for example, a home health aide, dialysis provider, or a cancer treatment provider).

I am a worker (for example, healthcare provider, security, environmental management) in a setting that provides direct care for suspected or confirmed COVID-19 patients (for example, a hospital managing COVID-19 patients, emergency department, urgent care clinic, walk-in clinic, respiratory clinic, an individual's home, or isolation and quarantine facility).

I am a first responder (for example, EMS, police or firefighter) in settings where direct care is provided to suspected or confirmed COVID-19 patients.

I am a worker in a health care setting at high risk of infection and transmission of COVID-19 because of my exposure to the general public.

I am a worker in a health care setting at low risk of infection and transmission of COVID-19, such as a remote worker or administrator who does not interact directly with the general public.

None of these describe me.

healthcare or LTCF eligible (hidden)

YESNO

Are you considered a critical worker according to the Washington Critical Infrastructure Worker list?If you're not sure, you can see the list here.

YESNO

Select all of the following statements that apply to you:

I am a teacher or staff member (for example, bus driver, food service) for a K-12 school.

I am a worker in a childcare setting.

I am an agricultural worker.

I work on a production line.

I work on a manufacturing line.

I work as part of a construction crew.

I am a worker at a corrections/detention facility.

None of these describe me.

Select any of the following statements that apply to you:

I currently live in (or work at) a homeless shelter.

I am a resident of a group home for people with disabilities, including mental illness, developmental or intellectual disabilities, and physical disabilities.

I am a resident of a group home for people in recovery.

I have a disability that prevents me from adopting protective measures against COVID-19.

I currently reside in a prison, jail or detention center.

None of these describe me.

Select any of the following statements about your work that apply to you:

At work, I am often sitting or standing within 6 feet of other people (customers or co-workers) indoors for 15 minutes or more, including travel to or from work.

I live with my co-workers (for example, sleep and eat).

I work with people who are vulnerable to COVID-19 (for example, sick or elderly people).

The surfaces where I work are not consistently cleaned and sanitized.

I have inadequate or inconsistent access to personal protective equipment that I need at work (for example, masks, face shields, or gloves).

None of these describe me.

If and when you are eligible, do you plan to get the COVID-19 vaccine?

Yes

Probably yes

Probably not

You are not yet eligible to get the COVID-19 vaccine.The Washington State Department of Health can notify you by text message or email when you are eligible to get the vaccine. Your contact information will remain private and will not be used for any other purpose. Please choose how you would like to be notified.

Text message

You are eligible to get the COVID-19 vaccine.* This field is required.Please enter your name below to get a confirmation message that you can show to a vaccine provider to demonstrate your eligibility.

First Name

Last Name

Please enter your email address

example@example.com

Please enter your phone number

Please enter a valid phone number.

eligible (hidden)

YESNO

Phase Finder WA / Encuentra Tu Fase