COVID19 Screening Survey

List of COVID-19 self-assessment questions to determine if you were exposed to COVID-19 (novel coronavirus) or have symptoms.

Questions for COVID19 Screening Survey

1.

Did you shake hands with anyone today?

The answer should be a text input.
2.

Did you touch your face during the past hour?

The answer should be a text input.
3.

Have you been outdoors during the past hour?

The answer should be a text input.
4.

Has anyone sneezed on you or coughed near you during the last 12-hours?

The answer should be a text input.
5.

Did you share a drink with someone in the last hour?

The answer should be a text input.
6.

Have you been to any public areas during the past hour (e.g., airport, shopping mall, theater)?

The answer should be a text input.
7.

Did you receive a flu vaccine this year?

The answer should be a text input.
8.

Have you traveled outside of the country during the past month?

The answer should be a text input.
9.

Has anyone around you been ill with cold symptoms in the last week?

The answer should be a text input.

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