​COVID-19 Survey

    Fish and Loaves
    ​    Taylor, MI 
    ​734-442-0031
    ​
    Symptoms Check
    I have experienced symptoms of COVID-19 in the past 14 days. Symptoms of COVID-19 include, but are not limited to:
    • Fever or chills
    • Cough
    • Shortness of breath
    • Difficulty breathing
    • Fatigue
    • Muscle or body aches
    • Headache
    • New loss of taste or smell
    • Sore throat
    • Congestion or runny nose
    • Nausea or vomiting
    • Diarrhea
    Testing
    I have tested positive for COVID-19 in the past 14 days or I am currently waiting on the results of a COVID-19 test.
    ​Contact
    I have knowingly been in close or proximate contact in the past 14 days with someone who has tested positive for COVID-19 or has or had symptoms of COVID-19.
    ​Travel
    I have traveled within the past 14 days to one of the states designated as having significant community spread, and I spent more than 24 hours in the state.
    ​Temperature check
    Please record the results of your temperature reading (all temperatures in F). A reading of 100.4 F or greater will result in a flagged survey.
    Your Information
    I have answered the above questions truthfully and to the best of my knowledge. I have read and agree to the privacy policy which describes how the submitted information will be used.