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Covid19

Covid-19 Self Assessment

Name: First & Last
In the last 24 hours, have you had any of the following symptoms:
- Shortness of breath
- Fever
- Cough
- Sore throat
- Body aches
In the last 14 days, have you or anyone you are close with traveled to a known Covid-19 hot spot?
In the last 14 days, have you had any contact with anyone who is exhibiting the symptoms listed above or is suspected of having Covid-19?