Global Ventures at FAU Covid-19 Questionnaire

Date (required)

Name (required)

Company/Organization (required)

Have you travelled to India, Brazil, Russia, France, United Kingdom or Turkey or the greater Los Angeles area, Miami Dade County, greater Chicago area, the greater Houston or the greater Phoenix area in the last fourteen (14) days? (required)

YES

Have you had close contact with anyone who has travelled to any of the countries or cities listed above in the last fourteen (14) days? (required)

YES

Have you had close contact with or cared for someone diagnosed with COVID-19 within the last fourteen (14) days? (required)

YES

Have you experienced any cold or flu-like symptoms in the last fourteen (14) days (including fever, cough, sore throat, respiratory illness, difficulty breathing)? (required)

YES

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