• Do you currently have ANY of these symptoms: 
  • temperature 100.0 degrees or higher,
  • sore throat or nose congestion, 
  • body aches, chills, or fatigue,
  • cough or shortness of breath,
  • headache,
  • new loss of taste or smell,
  • nausea, vomiting or diarrhea? 

YES                                NO

• Have you had any of these symptoms in the last 10 days?

YES                              NO

• Have you been diagnosed with COVID-19 in the past 6 weeks?

YES                             NO

• Have you been tested for COVID-19 recently, but have not received the results yet?

YES                             NO

• Have you had contact with someone with known or suspected COVID-19 in the last 14 days?

YES                              NO

• Have you traveled outside of Kansas or Missouri in the past 2 weeks?

YES                             NO

• Have you traveled on a cruise ship or river cruise within the last 2 weeks?

YES                               NO

• Have you attended a gathering 500 or more people (inside or outside), where individuals were not social distanced (6ft or more) AND wear a mask, in the last 2 weeks?                                    

YES                                 NO