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COVID-19 Symptom Checker
Chicago Blue RFC
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Date
MM
/
DD
/
YYYY
Name
Your answer
Are you currently diagnosed with or believe you may have COVID-19?
Yes
No
Clear selection
Have you been in contact with a COVID-19 confirmed or suspected case in the previous 14 days?
Yes
No
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Have you had any of these symptoms of COVID-19 in the past 14 days?
High temperature (fever):
Yes
No
Clear selection
A new continuous cough:
Yes
No
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New unexplained shortness of breath:
Yes
No
Clear selection
If you have answer YES to any of the following questions you should stay at home, inform your medical practitioner, and follow all public health guidance.
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