1.  Have you had any of the following symptoms in the last 14 days:

 a) Fever, Chills or history of fever

c) Cough  

e) New onset of headache 

g) Shortness of breath/respiratory difficulties

 b) Nasal Congestion  

d) Sore Throat

f) Acute loss of smell  

h) Loss of appetite   

2.Have you been in contact with a Covid 19 case in the last 14 days    

3. Have you been in contact with someone with respiratory tract infection in the last 14 days (such as a cold, pneumonia, etc)