Self-Assessment Tool for Coronavirus Risk

Hi! This coronavirus disease self-assessment tool has been developed on the basis of guidelines from the WHO.

Please do not consider this tool as expert medical advice. This is only for your reference to gauge whether the symptoms you identify as a part of the survey could indicate that the probability of you being coronavirus positive is high.

Please consult your doctor at the earliest if you feel any of the symptoms mentioned in the survey and follow their guidance for further course of action.

Any and all information shared as a part of the questionnaire is strictly confidential.

What is your age?

How do you identify yourself?

Male
Female
Prefer not to reveal

How are you feeling today?

Healthy
Unwell
Don't Know

What is your current body temperature?

(Normal body temperature is 98.6°F)

Are you experiencing any of the symptoms from the ones mentioned below?

(Choose all that are applicable)

In addition, please verify if you are experiencing any of the symptoms below

(Choose all that are applicable)

Please share your travel and exposure details

Do you have any of these medical conditions?

(Choose all that are applicable)

How have your symptoms progressed over the last 48 hours?

 
 
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