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1. Have you or any of your coinhabitants been diagnosed with Covid-19?

2. Have you been asked to quarantine or have you self-quarantined in the past 3 weeks?

3. Have you experienced any cold or flu like symptoms or any recent onset of respiratory problems, such as a cough, difficulty in breathing, sore throat, within the past 14 days?

4. If your answer is yes to the above question, have you visited a general physician?

5. Have you, travelled domestically/ internationally to states/countries with documented Covid-19 transmission within the past 45 days?

6. Have you come into contact with a patient with confirmed Covid-19 infection within the past 14 days?

7. Have you come into contact with people in your family or neighborhood with recent documented fever or respiratory problems within the past 14 days?

8. Have you recently participated in any gathering, meetings, or had close contact with many unacquainted people?

9. Do you have any medical issues?