COVID-19 SCREENING QUESTIONNAIRE
Your details will only be used for contact tracing and COVID-19 related protocols.
Sign in to Google to save your progress. Learn more
Full Name *
Cellphone Number *
Temperature *
Have you had any COVID-19 symptoms in the last two weeks? *
Have you been in contact with someone who has tested positive for COVID-19 in the last two weeks? *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy