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Symptom Checklist
Screening for Covid-19 like illness
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Do you have now, or at any time in the last 14 days have you had, any of the following: a fever, cough, sore throat, loss of taste or smell, chills, muscle aches, shortness of breath or diarrhea?
Yes
No
In the last 21 days have you had close contact with or cared for someone else who has or had confirmed or suspected Covid-19?
Yes
No
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Have you seen any new rashes, bumps, spots or lesions on your skin?
Yes
No
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