COVID-19 SELF ASSESSMENT Have you tested positive with a PCR or rapid COVID- 19 test within the past 10 days? Yes No Were you exposed to someone who tested positive for COVID-19? True exposure is defined as: – Being with the positive individual within 6 feet for more than 15 minutes cumulatively within a 24-hour period AND – The above exposure occurring during their illness OR within the 48 hours prior to their symptoms presenting OR within the 48 hours prior to their positive COVID-19 test (if they were asymptomatic to testing). Yes No Do you have 2 or more low-risk symptoms OR 1 or more high-risk symptoms? Low-Risk: General Symptoms (2 or more) – Fever (≥100.4°F)– Congestion/Runny Nose– Nausea/Vomiting/Diarrhea– Sore Throat– Headache– Fatigue/Muscle or Body Aches High-Risk: Red Flag Symptoms (1 or more) – Cough (new onset affecting quality of life)– Difficulty Breathing– Loss of Taste/Smell Yes No Submit your assessment now. Do you have 2 or more low-risk symptoms OR 1 or more high-risk symptoms?* Low-Risk: General Symptoms (2 or more) – Fever (≥100.4°F)– Congestion/Runny Nose– Nausea/Vomiting/Diarrhea– Sore Throat– Headache– Fatigue/Muscle or Body Aches High-Risk: Red Flag Symptoms (1 or more) – Cough (new onset affecting quality of life)– Difficulty Breathing– Loss of Taste/Smell Yes No Are you fully vaccinated? You are considered fully vaccinated if you have been boosted or completed a primary series of Pfizer or Moderna vaccines within the last 6 months. You are also considered fully vaccinated if you been boosted or have received the primary vaccine of Johnson & Johnson within the last 2 months. Yes No Time is Up! Time's up
Self Assessment This COVID-19 Self-Assessment does not replace professional medical advice, but can guide you on quarantining and isolation guidelines. Parents should help answer for children. Each member of the family can take this Self-Assessment to determine their specific quarantine/isolation guidelines. You may retake this self-evaluation at anytime during your quarantine if circumstances change. Have you tested positive with a PCR or rapid COVID- 19 test within the past 10 days? Yes No Were you exposed to someone who tested positive for COVID-19? True exposure is defined as: – Being with the positive individual within 6 feet for more than 15 minutes cumulatively within a 24-hour period AND – The above exposure occurring during their illness OR within the 48 hours prior to their symptoms presenting OR within the 48 hours prior to their positive COVID-19 test (if they were asymptomatic to testing). Yes No Do you have 2 or more low-risk symptoms OR 1 or more high-risk symptoms? Low-Risk: General Symptoms (2 or more) – Fever (≥100.4°F)– Congestion/Runny Nose– Nausea/Vomiting/Diarrhea– Sore Throat– Headache– Fatigue/Muscle or Body Aches High-Risk: Red Flag Symptoms (1 or more) – Cough (new onset affecting quality of life)– Difficulty Breathing– Loss of Taste/Smell Yes No Are you fully vaccinated? You are considered fully vaccinated if it has been at least 2 weeks since your first Johnson & Johnson vaccine or your second Pfizer/Moderna Vaccine. Yes No Time is Up! Time's up
Covid Assessment Have you tested positive with a PCR or rapid COVID- 19 test within the past 10 days? True exposure is defined as: – Being with the positive individual within 6 feet for more than 15 minutes cumulatively within a 24-hour period AND – The above exposure occurring during their illness OR within the 48 hours prior to their symptoms presenting OR within the 48 hours prior to their positive COVID-19 test (if they were asymptomatic to testing). Yes No Were you exposed to someone who tested positive for COVID-19? True exposure is defined as: – Being with the positive individual within 6 feet for more than 15 minutes cumulatively within a 24-hour period AND – The above exposure occurring during their illness OR within the 48 hours prior to their symptoms presenting OR within the 48 hours prior to their positive COVID-19 test (if they were asymptomatic to testing). Yes No Do you have 2 or more low-risk symptoms OR 1 or more high-risk symptoms? Low-Risk: General Symptoms (2 or more) – Fever (≥100.4°F)– Congestion/Runny Nose– Nausea/Vomiting/Diarrhea– Sore Throat– Headache– Fatigue/Muscle or Body Aches High-Risk: Red Flag Symptoms (1 or more) – Cough (new onset affecting quality of life)– Difficulty Breathing– Loss of Taste/Smell Yes No Are you fully vaccinated? You are considered fully vaccinated if it has been at least 2 weeks since your first Johnson & Johnson vaccine or your second Pfizer/Moderna Vaccine. Yes No Time is Up! Time's up
Covid19 Self Assessment This COVID-19 Self-Assessment does not replace professional medical advice, but can guide you on quarantining and isolation guidelines. Parents should help answer for children. Each member of the family can take this Self-Assessment to determine their specific quarantine/isolation guidelines. You may retake this self-evaluation at anytime during your quarantine if circumstances change. Have you tested positive with a PCR or rapid COVID- 19 test within the past 10 days? Yes No Were you exposed to someone who tested positive for COVID-19? True exposure is defined as: – Being with the positive individual within 6 feet for more than 15 minutes cumulatively within a 24-hour period AND – The above exposure occurring during their illness OR within the 48 hours prior to their symptoms presenting OR within the 48 hours prior to their positive COVID-19 test (if they were asymptomatic to testing). Yes No Do you have 2 or more low-risk symptoms OR 1 or more high-risk symptoms? Low-Risk: General Symptoms (2 or more) – Fever (≥100.4°F)– Congestion/Runny Nose– Nausea/Vomiting/Diarrhea– Sore Throat– Headache– Fatigue/Muscle or Body Aches High-Risk: Red Flag Symptoms (1 or more) – Cough (new onset affecting quality of life)– Difficulty Breathing– Loss of Taste/Smell Yes No Are you fully vaccinated? You are considered fully vaccinated if it has been at least 2 weeks since your first Johnson & Johnson vaccine or your second Pfizer/Moderna Vaccine. Yes No Time is Up! Time's up
Self Assessment Welcome to your Covid Self Assessment Were you exposed to someone who tested positive for COVID-19? True exposure is defined as: – Being with the positive individual within 6 feet for more than 15 minutes cumulatively within a 24-hour period AND – The above exposure occurring during their illness OR within the 48 hours prior to their symptoms presenting OR within the 48 hours prior to their positive COVID-19 test (if they were asymptomatic to testing). Yes No Do you have 2 or more low-risk symptoms OR 1 or more high-risk symptoms? Low-Risk: General Symptoms (2 or more) – Fever (≥100.4°F)– Congestion/Runny Nose– Nausea/Vomiting/Diarrhea– Sore Throat– Headache– Fatigue/Muscle or Body Aches High-Risk: Red Flag Symptoms (1 or more) – Cough (new onset affecting quality of life)– Difficulty Breathing– Loss of Taste/Smell Yes No Are you fully vaccinated? You are considered fully vaccinated if it has been at least 2 weeks since your first Johnson & Johnson vaccine or your second Pfizer/Moderna Vaccine. Yes No Time's up
