View source for COVID-19 screening questionnaire

Please answer all the following questions. If your answer to any of these questions is "YES", you should not participate in any research activities at this time.

#Are you experiencing any of the following: <small>[YES/NO]</small>
#*Severe difficulty breathing (e.g. struggling to breathe or speaking in single words)
#*Severe chest pain
#*Having a very hard time waking up
#*Feeling confused
#*Losing consciousness
#Are you experiencing any of the following: <small>[YES/NO]</small>
#*Mild to moderate shortness of breath
#*Inability to lie down because of difficulty breathing
#*Chronic health conditions that you are having difficulty managing because of difficulty breathing
#Are you experiencing any of the following: <small>[YES/NO]</small>
#*new or worsening cough
#*shortness of breath or difficulty breathing
#*temperature equal to or over 38°C
#*feeling feverish
#*chills
#*fatigue or weakness
#*muscle or body aches
#*new loss of smell or taste
#*headache
#*gastrointestinal symptoms (abdominal pain, diarrhea, vomiting)
#*feeling very unwell
#Have you travelled to any other countries within the last 14 days? <small>[YES/NO]</small>
#Within the last 14 days did you provide care or have close contact with a symptomatic person known or suspected to have COVID-19? <small>[YES/NO]</small>
#Did you have close contact with a person who travelled to another country in the last 14 days who has become ill (new or worsening cough; shortness of breath or difficulty breathing; temperature equal to or over 38°C; feeling feverish; chills; fatigue or weakness; muscle or body aches; new loss of smell or taste; headache; gastrointestinal symptoms (abdominal pain, diarrhea, vomiting); feeling very unwell)? <small>[YES/NO]</small>