In the past 14 days, have you or any household member travelled to areas of known cases of COVID-19?

In the past 14 days, have you or any household member had any contact with a known COVID-19 patient?

Have you or any household member, had/have a history of exposure to COVID-19 biologic material?

Have you had any known symptoms of COVID-19 eg; Fever, Dry Cough, Shortness of Breath, in the last 14 days?