Phone Name * I am working: * In-office Remote Have you experienced any of the following symptoms in the past 14 days unrelated to a known pre-existing condition (e.g. asthma, allergies)? * fever or chills fatigue diarrhea cough sore throat headache muscle or body aches nausea or vomiting congestion or runny nose shortness of breath or difficulty breathing new loss of taste or smell none of these Have you tested positive for COVID-19 in the last 14 days or are worried that you might be sick with COVID-19? * Yes No Have you been in close contact (i.e. within 6 feet for 15 minutes or greater) with or cared for anyone (including household members) who has been diagnosed with COVID-19 or who has symptoms consistent with COVID-19 within the last 14 days? * Yes No Are you or anyone in your household awaiting results of a COVID-19 test? * Yes No Have you traveled in the past 10 days? Travel is defined as any trip that is overnight AND on public transportation (plane, train, bus, Uber, Lyft, cab, etc.) or with people who are not in your household. * Yes No
