QUESTION

Please note that information from this chat will be used for monitoring and management of the current health crisis and research in the fight against COVID-19

1. Are you experiencing any of the following symptoms?

Cough Fever Difficulty in Breathing None of the Above

2. Have you ever had any one of the following:

Diabetes Hypertension Lung disease Heart disease None of the above

3. Have you travelled anywhere internationally in the last 14 days?

Yes No

4. Which of the following applies to you?

I have recently interacted or lived with someone who has tested positive for COVID-19
I am a healthcare worker and I examined a COVID-19 confirmed case without protective gear.
None of above.

5. Have you traveled anywhere internationally in the last 28-45 days?

Yes No

5. Have you traveled anywhere internationally in the last 28-45 days?

Yes No

6. Have you ever had any of the following:

Diabetes Hypertension Lung disease Heart Disease None of the Above