1. Have you had a fever of 100.0 F or greater in the last 72 hours?
  2. Have you had any of the following conditions in the last 24 hours? 
    • Fatigue 
    • Cough / sore throat 
    • Sneezing / runny nose 
    • Aches and pains 
    • Diarrhea 
    • Headaches 
    • Shortness of breath 
    • Loss of taste and smell 
  3. Have you recently been in close contact with anyone exhibiting these symptoms, in the last 10 days?
  4. Have you recently been in contact with anyone who has tested positive for COVID-19, in the last 10 days?