From-date can't be later than To-date
COVID Assessment
Are you experiencing any of these symptoms? (new, worsening, and not related to other known causes or
conditions)
- Fever / chills
- Cough
- Shortness of breath
- Decreased sense of smell / taste
- Sore throat
- Stuffy / runny nose
- Headache
- Nausea / vomiting / diarrhea
- Fatigue / lethargy / muscle aches
- Pink eye (Conjunctivitis) not related to other known causes or conditions (e.g., blepharitis, recurrent
styes)