COVID-19 Symptom Screening Tool

• Do you currently have a confirmed diagnosis of COVID-19?

  No Yes

• Are you currently self-isolating because you had close contact with a confirmed case of COVID-19?

  No Yes

• Have you had close contact** with anyone with suspected COVID illness in past 10 days?

  
  

  ** Not including those who work with COVID patients in healthcare settings in full personal protective equipment which includes surgical mask/N95 mask/respirator, with eye protection, at all times.

  No Yes

• Have you traveled to a region with high active cases of COVID in the past 14 days?

  No Yes

• Have you followed the return from travel requirements of the local government?

  Yes No

• Are you experiencing any of the following symptoms without other known cause:

  
  

  Cough, new or worsening

  Fever of 37.8°C/100°F or higher

  Chills

  Shortness of breath, difficulty breathing

  Decrease or loss of sense of taste or smell

  Other Symptoms may include

  Headache and sore throat

  Over 18 years of age: Unexplained fatigue, malaise and muscles aches

  Under 18 years of age: Nausea, vomiting, diarrhea, abdominal pain

  No Yes

• Are you currently waiting for COVID-19 test results?

  No Yes