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COVID-19 Symptoms Assessment

Personal Information

Are you fully vaccinated against Covid-19?

Fully vaccinated means 2 weeks after your second dose in a 2-dose series, such as Pfizer or Moderna vaccines, or 2 weeks after a single-dose vaccine, such as Johnson & Johnson’s

Have you had your RT-PCR test done?

If yes, please indicate information:

Upload test result here

Select File

Are you a Close Contact Person to a Confirmed Covid-19 Case?

Are you currently experiencing any of the following symptoms? 

Fever or chills

Cough

Colds

Shortness or difficulty of breathing

Tiredness

Muscle or

body aches

Headache

Loss of taste or smell

Sore throat

Diarrhea

TEMPERATURE READING :

List of Close Contact Persons

Close contact means:

  1. face to face contact with or without facemask within 1 meter for more than 15 minutes e.g., talking, meeting

  2. direct physical contact e.g., shake hands, cheek greetings

  3. direct care for confirmed or suspect for Covid-19 without using approved PPE

  4. persons you ate with (indoor, regardless of distance), (outdoor within or less than 1 meter distance)

Thank you for completing this Covid-19 Symptoms Assessment.

Who to contact:

Email         nursejmarquez@gesm.org

                 mhombrobueno@gesm.org

                 +639171249158  

More Information

What to do if you are sick:

Kindly accomplish the web-based questionnaire for assessment