| Yes | No |
Q1: Are you immunocompromised and/or live in a highest-risk congregate care setting? | | |
Q2: Do you have any of these symptoms? Choose any or all that are new, worsening and not related to other known causes or conditions.- Fever and/or chills
- Cough or Barking Cough
- Shortness of breath
- Decrease or loss of sense of taste or smell
- Muscle aches/joint pain
- Extreme tiredness
- Sore throat
- Runny or stuffy nose
- Headache
- Nausea, vomiting and/or diarrhea
- Abdominal Pain
- Pink Eye
| | |
Q3: Have you been told (by a doctor, health care provider, public health unit, federal border agent, or other government authority) that you should currently be quarantining, isolating or staying at home? | | |
Q4: In the last 10 days, have you tested positive for COVID-19 on a laboratory-based PCR test, rapid molecular test, rapid antigen test or other home-based self-testing kit? | | |