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CDC FACILITIES COVID-19 SCREENING

1 of 4CS326233-DSTOPTODAY S DATE: _____PLEASE READ EACHQUESTION CAREFULLY1. Regardless of your vaccination status, have you experienced any of the symptoms in the list below in the past 48 hours? IMPORTANT: ANSWER YES EVEN IF YOU BELIEVE THE SYMPTOM(S) IS BECAUSE OF SOME OTHER MEDICAL CONDITION (FOR EXAMPLE, ANSWER YES IF YOU HAVE A RUNNY NOSE BECAUSE OF ALLERGIES).2. Are you isolating or quarantining because you tested positive for COVID-19 or are worried that you may be sick with COVID-19 ?PLEASE CIRCLE THE ANSWER THAT APPLIESTO YOU AND FOLLOW THE INSTRUCTIONS BASED ON YOUR RESPONSECDC FACILITIES COVID-19 SCREENINGA ccessible version available at fever or chills cough shortness of breath or difficulty breathing fatigue muscle or body aches headache new loss of taste or smell sore throat congestion or runny

CS326233-D 1 of 4 STOP TODAY’S DATE: _____ PLEASE READ EACH QUESTION CAREFULLY 1. Regardless of your vaccination status, have you experienced any of …

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