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                                                                                                                                                                CRIS





                                                                                                                                                                          COVID-19 Assessment





                                                                                                                                                                 During the last 3 days have you had any of the following
                                                                                                                                                                 symptoms?
                                                                                                                                                                 .  Sore throat
                                                                                                                                                                 .  Shortness of breath or di culty breathing
                                                                                                                                                                 .  Unexplained muscle pain
                                                                                                                                                                 .  Dry cough
                                                                                                                                                                 .  Loss of smell or taste





                                                                                                                                                                                               Yes




                                                                                                                                                                                               No
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