COVID DAILY SYMPTOM SCREENING QUESTIONNAIRE
Do you currently have (or had within the past 3 days) any of these symptoms that you cannot attribute to another condition? YES or NO
- Fever or chills
- Cough or sore throat
- Shortness of breath or difficulty breathing
- Fatigue
- Muscle or body aches
- Headache
- Recent onset of loss of taste or smell
- Congestion
- Nausea or vomiting
- Diarrhea
Have you had close contact with anyone with COVID-19 or COVID-19 symptoms in the past 14 days? YES or NO
Contact is defined as being within 6 feet for more than 15 minutes with a person, or having direct contact with infectious fluids from a person with confirmed COVID-19 (for example being coughed or sneezed on).
Have you had a positive-COVID test for active virus in the past 14 days? YES or NO