Migynae Covid-19 Screening Questionaire Question Title * 1. What is your full name? Question Title * 2. Are you awaiting a COVID-19 test result? Yes No Question Title * 3. Have you been diagnosed with COVID-19, but have not yet been cleared by the Department of Health? Yes No Question Title * 4. Do you have new/recent-onset symptoms consistent with COVID-19? (loss of change in sense of smell or taste/fever/chills or sweats/cough/sore throat/shortness of breath/runny nose/headache/muscle soreness/stuffy nose/nausea/vomiting/diarrhoea) Yes No Question Title * 5. Have you had contact in the past 14 days with someone with COVID-19? (except at health care work settings whilst wearing appropriate personal protective equipment) Yes No Question Title * 6. Are you currently required to self-isolate or self-quarantine under the Diagnosed Persons and Closed Contacts Directions of DHHS Victoria because you may have been exposed to COVID-19? Yes No Question Title * 7. Have you entered Victoria from a cross-border area without a cross-border permit, exception or exemption? Yes No Question Title * 8. Do you currently hold a RED or ORANGE zone permit under the Victoria Travel Permit System? Yes No Question Title * 9. Have you visited a Tier 1 exposure site in the past 14 days? Please click the link for list of Exposure sites Victoria Yes No Question Title * 10. Have you visited a Tier 2 exposure site in the past 14 days? Please click the link for the list of Exposure sites Victoria Yes No Question Title * 11. Have you been to a hotel quarantine or port-of-entry facility in the past 14 days? (if you have, please inform staff of your days 17 and 21 COVID-19 test results to keep the facility COVIDsafe) Yes No 33% of survey complete. Next