COVID-19

Colorado Screening Questionnaire

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  1. Cough

  2. Fever

  3. Shortness of breath, or

  4. Sore throat

Are you currently experiencing any of the following symptoms:

Yes

No

Have you traveled in an airplane or on a cruise ship in the last 14 days?

Yes

No

Have you traveled internationally in the last 14 days?

Yes

No

Have you visited or do you reside in a community with confirmed community spread of COVID-19?

Yes

No

Have you spent time (more than 5 minutes) within 6 feet distance with any one who has tested positive or is under investigation for COVID-19?

Yes

No

Did you spend time (more than 5 minutes) within 6 feet distance with a person who had been to ANY foreign country?

Yes

No

Did you spend more than 5 minutes time within 6 feet of a person who did have, or was under investigation for COVID-19?

Yes

No

Recommendation

You may have been exposed to the Coronavirus (COVID-19) you should implement: 

 

Quarantine or self-quarantine 

 

Recommendation

You either have or at high risk of having Coronavirus (COVID-19) you should implement: 

 

Isolation or self-isolation 

 

Recommendation

You are not at high risk for COVID-19,

but stay vigilant.

Consider practicing

self-quarantine 

Thank You!

Visit the Colorado Coronavirus website for more information.

Colorado COVID-19 Questionnaire

By Russell Castagnaro

Colorado COVID-19 Questionnaire

State of Colorado COVID-19 Self Assessment Questionnaire

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