Covid 19 Questionnaire Form

Do you currently have any flu like symptoms (i.e cough, runny nose, fever, sore throat) or shortness of breath? *

Have you been unwell in the last 14 days? *

In the past 14 days, have you been to Victoria/overseas or visited any of the COVID19 hotspots in NSW e.g. Wetherill Park Stocklands Mall, Crossroads Pub/Hotel, Planet Fitness Casula, Picton Hotel? *

Are you in close contact or living with any persons who have either recently come back from overseas/Victoria/NSW COVID19 hotspots or have been ill in the last 14 days? *

Have you been in close contact with a person with confirmed COVID19 in the last 14 days? (skip the next 3 questions if you selected No) *