Covid Self Assessment Form

Fever and/or Chills
Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or higher
Cough or barking cough (croup)
Continuous, more than usual, making a whistling noise when breathing (not related to asthma, post-infectious reactive airways, COPD, or other known causes or conditions you already have)
Shortness of breath
Out of breath, unable to breathe deeply (not related to asthma or other known causes or conditions you already have)
Decrease or loss of taste or smell
Not related to seasonal allergies, neurological disorders, or other known causes or conditions you already have
Muscle aches/joint pain
Unusual, long-lasting (not related to getting a COVID-19 vaccine and/or flu shot in the last 48 hours, a sudden injury, fibromyalgia, or other known causes or conditions you already have)
Extreme tiredness
Unusual, fatigue, lack of energy (not related to getting a COVID-19 vaccine and/or flu shot in the last 48 hours, depression, insomnia, thyroid dysfunction, or other known causes or conditions you already have)
Sore throat
Painful or difficulty swallowing (not related to post-nasal drip, acid reflux, or other known causes or conditions you already have)
Runny or stuffy/congested nose
Not related to seasonal allergies, being outside in cold weather, or other known causes or conditions you already have
Headache
New, unusual, long-lasting (not related to getting a COVID-19 vaccine and/or flu shot in the last 48 hours, tension-type headaches, chronic migraines, or other known causes or conditions you already have)
Nausea, vomiting and/or diarrhea
Not related to irritable bowel syndrome, anxiety, menstrual cramps, medication side effects, or other known causes or conditions you already have
None of the above
Select "None of the above" if all of these apply: - You have completed your isolation period of 5 days or you tested negative for COVID‐19 on one PCR test or rapid molecular test or two rapid antigen tests taken 24 to 48 hours apart, and - You do not have a fever, and your symptoms have been improving for 24 hours (48 hours if you have nausea, vomiting, and/or diarrhea)