COVID Health Questionnaire Screening-SPARC
Email address *
Participant Name: *
Parent/Guardian Name: *
In the last 14 days, have you or anyone living with you tested positive for Covid? *
Have you or anyone living with you developed any of the following symptoms within the last 24 hours: fever of 100 degrees Fahrenheit, coughing, shortness of breath/difficulty breathing, fatigue, sore throat, congestion, nausea, diarrhea, sore throat, or reduced sense of smell or taste? *
In the past 14 days, have you been in close contact with anyone who has tested positive for Covid-19? *
In the the last 14 days, have you travelled internationally or to any state that will require you to quarantine? *
A copy of your responses will be emailed to the address you provided.
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