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 visited any of the COVID19 hotspots? If unsure, please check at bit.ly/NSWHotspot *

Are you in close contact or living with any persons who have either recently come back from 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? *