1. Have you or anyone in your household had a fever in the last three (3) days, respiratory symptoms (cough and shortness of breath), flu-like symptoms or have been in contact with anyone with a confirmed case of COVID-19? | | |
2. Other than healthcare professionals working in patient care, are you currently providing care for anyone how has been diagnosed with COVID-19, had a fever, cough, difficulty breathing or flu-like symptoms in the last 2 weeks? | | |
3. Have you traveled internationally in the last 2 weeks? | | |
4. Are you or anyone in your household under voluntary or involuntary quarantine in the last 2 weeks? | | |
5. Have you or anyone in your household traveled to an area with community spread of COVID-19 in the last 14 days? | | |