COVID Health Questionnaire Screening-SPARC

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Email *

Participant or Staff Name: *

Parent/Guardian Name:

In the last 10 days, have you or anyone living with you tested positive for Covid? *

Yes

Have you or anyone living with you developed any of the following symptoms within the last 24 hours: fever of 100 degrees Fahrenheit, coughing, shortness of breath/difficulty breathing, fatigue, sore throat, congestion, nausea, diarrhea, sore throat, or reduced sense of smell or taste? *

Yes

In the past 10 days, have you been in close contact with anyone who has tested positive for Covid-19? *

Yes

A copy of your responses will be emailed to the address you provided.

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