1) In the last 10 days, have you experienced any of these symptoms? Choose yes for any/all that are new, worsening, and not related to other known causes or conditions you already have.
Fever and/or Chills
Cough or barking cough (croup)
Shortness of breath
Decrease or loss of smell or taste
Muscle aches/joint pain
Fatigue
Sore throat
Runny or stuffy/congested nose
Headache
Nausea, vomitting and/or diarrhea
2) Have you been told you that you should currently be quarantining, isolating, staying at home, or not attending a highest risk setting (e.g., LTCH or RH)?
This can be becasue of an outbreak or contact tracing. If the LTCH you are seekingto enter allows you to work in self-isolation (e.g. test-to-work), select "No"
3) In the last 10 days (regardless of whether you are currently self-isolating or not), have you been identified as a “close contact” of someone (regardless of whether you live with them or not) who has tested positive for COVID-19 or have symptoms consistent with COVID-19?
Select "No" if: you completed your isolation period after testing positive for COVID-19 in the last 90 days (using a rapid antigen, rapid molecular or PCR test); and/or your close contact is isolating because of COVID-19 symptoms but has already recieved a negative PCR or rapid molecular test, or two negative rapid antigen tests 24-48 hours apart.
4) In the last 10 days (regardless of whether you are currently self-isolating or not), have you tested positive for COVID-19, including on a rapid antigen test or a home-based self-testing kit?
If you have since tested negative on a lab-based PCR test or if the LTCH you are seeking to enter allows you to work in self-isolation (e.g. test-to-work), select "No".