COVID-19 HEALTH SCREENING SURVEY

QUESTION 1 OF 3

Have you been diagnosed with COVID-19 within the last 14 days?

QUESTION 2 OF 3

Do you have any of the following symptoms: fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomitting, or diarrhea?

QUESTION 3 OF 3

Within the last 14 days have you had close contact with any individual who has been diagnosed with COVID-19 within the last 14 days? Close contact generally means that you were within 6 feet of someone with that diagnosis for 10 minutes or more, or the person coughed or sneezed on you, or you touched a tissue or other object that the person had recently used.