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COVID-19 Visitor Questionnaire
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* Indicates required question
Have you traveled to any of these locations in the last 14 days?
*
China
Iran
South Korea
Italy
Japan
None of the above
Required
Have you had contact with anyone with confirmed COVID-19 in the last 14 days?
*
Yes
No
Have you had any of these symptoms in the last 14 days?
*
Fever greater than 100
Difficulty breathing
Cough
None of the above
Required
Are you currently experiencing fever over 100, difficulty breathing or cough?
*
Yes
No
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