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Covid-19 Screening Form
Are you experiencing any of the following symptoms with unknown cause: fever, cough, shortness of breath, muscle pain, loss of taste or loss of smell?
Yes
No
Have you had close contact with any person IN SELF ISOLATION, QUARANTINE or under investigation for COVID-19 in the past 14 days?
Yes
No
Have you been in close contact with anyone who has been traveling internationally recently?
Yes
No
Have you had contact in the last 14 days with a person being tested with Covid-19?
Yes
No
Submit Answers
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