1. In the last 10 days have you experienced any of the following symptoms?
- Fever and/or chills - Temperature of 37.8oC/100oF or higher.
- Cough or barking cough (croup)
- Shortness of breath
- Decrease or loss of smell or taste
SELECT “NO” if:
You are fully vaccinated and not immune compromised OR under 12 years old and not immune compromised:
AND experienced the symptom(s) over 5 days ago
AND symptom(s) have been improving over 24h
AND you do not have a fever
OR
You are symptomatic BUT ALSO tested negative for COVID -19 on a single PCR test or 2 rapid antigen tests (RAT) taken 24-48h apart
AND symptom(s) have been improving over 24h
AND you do not have a fever
OR
You are unvaccinated OR immune compromised:
AND experienced the start of symptom(s) over 10 days ago
AND symptom(s) have been improving over 24h
AND you do not have a fever
2. In the last 10 days have you experienced any of the following symptoms?
- Runny or stuffy/ congested nose
- Sore throat
- Headache
- Muscle aches/ joint pain
- Fatigue
- Nausea, vomiting and/or diarrhea
SELECT “NO” if:
You are fully vaccinated and not immune compromised or under 12 years old and not immune compromised:
AND experienced the symptom(s) over 5 days ago
AND symptom(s) have been improving over 24h (48h for gastrointestinal symptoms)
AND you do not have a fever
OR
You are symptomatic BUT ALSO tested negative for COVID -19 on a single PCR test or 2 rapid antigen tests (RAT) taken 24-48h apart
AND symptom(s) have been improving over 24h (48h for gastrointestinal symptoms)
AND you do not have a fever
OR
You are unvaccinated OR immune compromised
AND experienced the start of symptom(s) over 10 days ago
AND symptom(s) have been improving over 24h (48h for gastrointestinal symptoms)
AND you do not have a fever
5. In the last 10 days, have you tested positive for COVID-19?
SELECT “NO” if:
You are fully vaccinated OR under 12 years of age and not immune compromised and the test was more than 5 days ago
6. Do any of the following apply?
- You live with someone who is currently isolating because of a positive COVID19 test
- You live with someone who is currently isolating because of COVID-19 symptoms
- You live with someone who is waiting for COVID-19 test results
SELECT “NO” if:
You tested positive for COVID-19 (on a lab-based PCR test, rapid antigen test or home-based self-testing kit) within the last 90 days AND have already completed your isolation period