COVID-19 Self-Screening Tool

Please note that this is not a medical assessment. If you are experiencing severe symptoms, call 911.

Question 1

In the past 14 days, have you experienced any of the following: fever (>99.9°F), chills, body aches, cough, runny nose, sore throat, shortness of breath, difficulty breathing, and/or diarrhea?

Yes No

Question 2

In the past 14 days, have you been in close contact with someone suspected or confirmed to have the coronavirus? Close contact is within 6 feet for 3 or more minutes.

Yes No

Question 3

In the past 14 days, have you been notified or aware of any exposure to a confirmed or suspected case of COVID-19?

Yes No

Question 4

In the past 14 days, have you traveled to or from any country, region, state or area with active COVID-19?

Yes No

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COVID-19 Self-Screening Tool

Question 1

Question 2

Question 3

Question 4

You should immediately limit your contact with others and isolate.