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COVID-19 Self Check

COVID-19 Self Check form instruction for creators

  • The following 6 questions are most commonly used COVID-19 self check questions. If any of these have a 'YES' answer, a more in-depth diagnosis may be required.
  • Add more questions or pages if you need.
  • The instruction you are reading now is a guide for form makers, so please delete it and use the self check form.

Did you visit any foreign countries within the last 14 days?

YES

NO

Do you live with a family member(or a domestic partner) who visited foreign countries within the 14 days?

YES

NO

Have you had contact with a confirmed COVID-19 patient within the last 14 days?

YES

NO

Did you visit any regional districsts or failities within Korea where mass outbreaks of the COVID-19 occurred within the last 14 days?

YES

NO

Have you ever been contacted by the Centers for Disease Control and Prevention to report that you have contacted a confirmed COVID-19 patient (or contact person)?

YES

NO

Do you currently have fever, respiratory symtom(cough, breathing difficulties, pneumonia), sore throat, or loss of taste or smell?

YES

NO

Did you answer the above questions without falsehood?

YES, I did