Circadian rhythms - COVID SAFE Trace

Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Covid Screening 1 *

Have you been in close contact with a person who is positive for COVID-19?

Yes

No

Covid screening 2 *

Are you an active COVID-19 case?

Yes

No

Covid screening 3 *

Are you currently, or have you recently experienced cough, fever, sore throat, fatigue, loss of smell or taste, vomiting, diarrhoea or shortness of breath?

Yes

No