JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
COVID-19 Symptom Check
1st Self-Certification
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Last Name
*
Your answer
First Name
*
Your answer
Fever, Cough, Chills, and/or Muscle Aches
*
Yes
No
Sore Throat and/or Loss of Taste/Smell
*
Yes
No
Vomiting, and/or Diarrhea
*
Yes
No
Headache
*
Yes
No
Close Contact or Cared for Someone with COVID-19
*
Yes
No
Temperature
*
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Galva Community Unit School District 224.
Report Abuse
Forms
