VOLUNTEER SURVEY

JEEP BEACH COVID-19 SELF-SCREENING
PLEASE READ EACH QUESTION CAREFULLY AND ANSWER THE FOLLOWING QUESTIONS.

Have you experienced any fever or chills (including running a temperature above or below normal) in the past 48 hours?

Have you experienced any cough in the past 48 hours?

Have you experienced any shortness of breath or difficulty breathing in the past 48 hours?

Have you experienced any fatigue in the past 48 hours?

Have you experienced any muscle or body aches in the past 48 hours?

Have you experienced any headaches in the past 48 hours?

Have you experienced any new loss of taste or smell in the past 48 hours?

Have you experienced any sore throat in the past 48 hours?

Have you experienced any congestion or runny nose in the past 48 hours?

Have you experienced any nausea or vomiting in the past 48 hours?

Have you experienced any diarrhea in the past 48 hours?

Within the past 14 days, have you been in close physical contact (6 feet or closer for a cumulative total of 15 minutes) with anyone who is known to have laboratory-confirmed COVID-19?

Within the past 14 days, have you been in close physical contact (6 feet or closer for a cumulative total of 15 minutes) with anyone who has any symptoms consistent with COVID-19?

Are you isolating or quarantining because you may have been exposed to a person with COVID-19 or are worried that you may be sick with COVID-19?

Are you currently waiting on the results of a COVID-19 test?

Have you received COVID-19 vaccination?

13 + 2 =