ELL Center PMP COVID self check

Do you have any of the following symptoms? *

Feeling feverish (such as chills, sweating)

Cough

Mild or moderate difficulty breathing

Sore throat

Muscle aches or body aches

Vomiting or Diarrhea

Loss of taste or smell

Congestion or runny nose

None of the above

In the last two weeks, did you have close contact with someone with symptoms of COVID, tested for or diagnosed with COVID? *

Yes

No

Maybe

*

I hereby declare that the details above are true and correct to the best of my knowledge.

Required