Covid-19 Questionnaire Covid-19 Questionnaire If you are human, leave this field blank. Name * Al Chudnovsky Alfredo Pimentel Atley Stock Andre Smith Austin McClenaghan Bari McFarland Brad Thompson David Coulter Doug Verpaelst Gabe Jenkinson James Murphy JF Lemieux Joe Hammill John Gobel Josh Reisman Kelly Douglas Lori Reynolds Nigel Hollidge Richard Gobel Robert Link Ryan Chatwin Shar Harbridge Teena Mason Tyler Gobel Do you have any of the following symptoms or signs? Do you have a fever? (take temperature, fever is a temperature of 37.8 Celcuis or greater) Shortness of breath Sore throat Runny nose or sneezing Nasal congestion Hoarse voice Difficulty Swallowing New smell or taste disorder(s) Nausea/vomiting, diarrhea, abdominal pain Unexplained fatigue/malaise Chills Headache Have you travelled or had close contact with anyone that has travelled in the past 14 days? Have you had close contact with anyone with respiratory illness or a confirmed or probable case of COVID-19? Have you been in social settings including 5 or more people? Answer - If the answer is yes to any of the above questions, indicate yes below. Yes No Please explain below and immediately contact Bari McFarland at (705) 826-2295 Submit
