COVID Questionnaire

COVID-19 screening questions:
• Have you traveled out of the region in the last 14 days?
• When? Where? See below.

If you have traveled to/from any of the following states or internationally, we suggest you
quarantine at home (especially if exhibiting symptoms) for 14 days after returning to PA:
• Alabama
• Arkansas
• California
• Florida
• Georgia
• Hawaii
• Idaho
• Illinois
• Kansas
• Louisiana
• Mississippi
• Missouri
• Nevada
• North Carolina
• Oklahoma
• South Carolina
• South Dakota
• Tennessee
• Texas

Do you have any of these symptoms?
• Fever or chills
• Cough
• Shortness of breath or difficulty breathing
• Fatigue
• Muscle or body aches
• Headache
• New loss of taste or smell
• Sore throat
• Congestion or runny nose
• Nausea or vomiting
• Diarrhea

If you answered “YES” to any of the above symptoms, please stay home and contact your
healthcare provider

Have you had contact with a confirmed COVID-19 patient?
• If yes: Are you being monitored by the health department?

If you answered “YES” to any of the above questions, please stay home and contact your
healthcare provider and consider participating in our online Zoom sessions on Tuesday evenings