Exit MGUC Covid19 Survey Maple Grove United Church Covid19 Survey Question Title * 1. What is your name? Question Title * 2. What is your phone number? Question Title * 3. Are you experiencing any of the following COVID-19 symptoms: Fever Dry cough Extreme fatigue Difficulty breathing Loss of sense of smell None Question Title * 4. In the past 14 days have you travelled outside of Canada or been in close contact with someone who has travelled outside of Canada? Yes No Question Title * 5. In the past 14 days have you, or someone you have been in close contact with, tested positive for COVID-19? Yes No Question Title * 6. In the past 14 days have you been in close contact with someone with severe respiratory illness or issues? Yes No Done