• University of La Verne Daily Health Questionnaire

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  • Have you tested positive for COVID-19 in the last 10 days? (Ha dado positivo en COVID-19 en los últimos 10 días?)*
  • Have you been in contact with anyone that was diagnosed with COVID-19 in the last 14 days? (Ha estado cerca de alguien que fue diagnosticado con COVID-19 en los últimos 14 días?)*
  • Have you felt sick today? (Se ha sentido enfermo/a hoy)*

  •  COVID-19 Symptoms include (Sintomas de COVID-19 incluen):

    • Fever or chills (Fiebre o escalofríos)
    • Cough (Tos)
    • Shortness of breath or difficulty breathing (Dificultad para respirar)
    • Fatigue (Fatiga)
    • Muscle or body aches (Dolores musculares o corporales)
    • Headache (Dolor de cabeza)
    • New loss of taste or smell (Nueva pérdida de sabor u olor)
    • Sore throat (Dolor de garganta)
    • Nasal congestion or runny nose (Congestión nasal o nariz con nequeo)
  • Are you experiencing any of the COVID-19 related symptoms noted above? (Tiene alguno de los síntomas mencionados?)*
  • Date
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     :

  • I certify all the information provided is shared to the best of my ability.

  • Should be Empty: