Coronavirus Self-Checker

Name

First Last

I am a*

Wiley Email*

Have you traveled to another state within the past 14 days? If so, please list the state(s).

Do you have any of the following? 1. Cough 2. Fever or chills 3. Shortness of breath or difficulty breathing 4. Muscle or body aches 5. Sore throat 6. New loss of taste or smell 7. Diarrhea 8. Headache 9. Nausea or vomiting 10. New fatigue 11. Congestion or runny nose*

No
Yes

Have you had close contact with someone diagnosed with COVID-19 or been notified that you may have been exposed to it?*

No
Yes

Temperature*