This is the Spanish page for the COVID Screening Questionnaire. Click below for other languages:
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Spanish
What is your full name?
What is your date of birth?
Answer option for these questions: Yes or No
Travel Screening
Have you traveled outside the US in the last 30 days?
Symptom Screening
Have you had a fever or felt feverish in the past 24 hours?
Have you had contact with a known or suspected case of COVID-19?
Do you have trouble breathing or a new cough?
Are you having nausea, vomiting, or diarrhea?
Do you have a new rash?
Do you have any of the following new symptoms?
Sore throat
Muscle Aches
Severe Dizziness/Fainting
Anosmia (Change in Smell)
Chest Pain
Nasal Congestion
None
