Questions

1. Have you had any symptoms of COVID-19 (cough, fever, shortness of breath, change in taste or smell) in the past 14 days? *

   Yes

   No

2. Have you been exposed to a person infected with COVID-19 in the past 14 days? *

   Yes

   No

3. Are you waiting for a test result for COVID-19? *

   Yes

   No

4. Have you traveled outside the country in the last 14 days? *

   Yes

   No

5. Have you tested positive for COVID-19 in the last 14 days? *

   Yes

   No

6. Have you had a voluntary isolation order issued by a public health authority within the last 14 days? *

   Yes

   No

7. Does anyone in your household have one or more symptoms of COVID-19 (cough, fever, shortness of breath, change in taste or smell) and/or is waiting for test results after experiencing symptoms? *

   Yes

   No

8. In the past 10 days, have you tested positive on a rapid home test? *

   Yes

   No

9. Do you live with a confirmed COVID-19 positive case? *

   Yes

   No

10. Do you live with a suspected case or a person in isolation following close contact with a variant case? *

    Yes

    No