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.

1. Are you experiencing any of the following: [YES/NO]
   • 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
2. Are you experiencing any of the following: [YES/NO]
   • 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
3. Are you experiencing any of the following: [YES/NO]
   • 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
4. Have you travelled to any other countries within the last 14 days? [YES/NO]
5. Within the last 14 days did you provide care or have close contact with a symptomatic person known or suspected to have COVID-19? [YES/NO]
6. 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)? [YES/NO]