Questionnaire | Shor Yoshuv

DO YOU HAVE A RUNNY NOSE?

Yes

No

DO YOU HAVE A SORE THROAT?

Yes

No

DO YOU HAVE A FEVER OVER 100 DEGREES, OR HAVE YOU EXPERIENCED A FEVER WITHIN THE PAST 14 DAYS?

Yes

No

HAVE YOU EXPERIENCED A RECENT ONSET OF RESPIRATORY PROBLEMS, SUCH AS A COUGH OR DIFFICULTY IN BREATHING WITHIN THE PAST 14 DAYS?

Yes

No

IN THE LAST 14 DAYS, HAVE YOU EXPERIENCED A LOSS OF TASTE AND / OR SMELL?

Yes

No

ARE YOU EXPERIENCING BODY OR MUSCLE ACHES OF ANY KIND, REGARDLESS OF THE PAIN INTENSITY?

Yes

No

WITHIN THE LAST 14 DAYS, HAVE YOU TRAVELED OUTSIDE OF NY STATE OR KENT CT.?

Yes

No

HAVE YOU COME INTO CONTACT WITH A PERSON WITH CONFIRMED COVID-19 INFECTION WITHIN THE PAST 14 DAYS?

Yes

No

HAVE YOU ATTENDED ANY TYPE OF MASS SOCIAL GATHERING (EVEN WITHOUT DANCING) SUCH AS A, CHASUNA, VORT, BAR MITZVAH, KIDDUSH, REGARDLESS IF IT IS INDOORS OR OUTDOORS IN THE PAST 7 DAYS?

Yes

No

Shor Yoshuv - Daily Covid Questionnaire