| SYMPTOMS | Y/N |
| Do you have cough? | |
| Do you have colds? | |
| Do you have Diarrhea? | |
| Do you have Sore Throat? | |
| Are you experiencing MYALGIA or Body Aches? | |
| Do you have a Headache? | |
| Do you have Fever (37.8°C or above)? | |
| Are you having Difficulty Breathing? | |
| Are you experiencing Fatigue? | |
| Have you travelled during the past 14 days? | |
| Do you have a travel history to a COVID-19 Infected Area? | |
|
Do you have direct contact or is taking care of a positive COVID-19 patient? |