Survey 2 – CliniKits

Have you been exposed to the coronavirus in the past 2 weeks?

Please select the option that most closely describes your level of exposure:

Testing Recommended

I’ve been asked to get testing by my healthcare provider, public health department, or a contact Investigator.

Exposed or Sick Contact

Yes, I have been in close proximity* to someone who has been diagnosed with or presumed to have COVID-19.

*Within 6 ft. of the person for a prolonged period of time or being coughed on.

Congregate Setting

Yes, I live or work in a place where people reside, meet, or gather in close proximity.*

*Includes nursing homes or other long term care facilities, healthcare
settings, office buildings, workplaces, schools, group homes, homeless
shelters, prisons, and detention centers.

*If you feel like you are having a medical emergency, please call 9-1-1. If you are experiencing severe trouble breathing; continuous pain or pressure in your chest; feeling confused; or having diﬃculty waking up or staying awake; pale, gray, or blue-colored skin, lips, or nail beds; or any other emergency signs or symptoms, please seek immediate medical care.

Have you been exposed to the coronavirus in the past 2 weeks?

Testing Recommended

Exposed or Sick Contact

Congregate Setting

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