Blank Quiz

Do you currently have symptoms of a respiratory infection? *

Yes

No

Do you have fever, shortness of breath, cough, sore throat, or loss of smell? *

5 points

Yes

No

Have you traveled outside the country within the past 10 days? *

5 points

Yes

No

Have you been exposed to someone who has tested positive or diagnosed with COVID-19? *

5 points

Yes

No

Have you received the Covid-19 vaccination? *

5 points

Yes

No

Partial Vaccination

Complete Vaccination