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COVID-19 Health Screening Questionnaire
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* Indicates required question
Full Name:
*
Your answer
In the last 48hrs, have you experienced any of the following:
Fever > 100.4 F? *
*
Yes
No
Muscle aches, body chills, fatigue? *
*
Yes
No
Shortness of breath/difficulty breathing? *
*
Yes
No
Headache, fever, or cough? *
*
Yes
No
Nasal congestion or sore throat? *
*
Yes
No
Have you been exposed to any known positive COVID-19 cases?
*
Yes
No
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