COVID-19-self-assessment (Giekau, en)

Data protection notice

Your entries in the questionnaire are private, but can be saved in PDF format at the end. As soon as you close this browser window, all entries will be deleted.

When did you have contact with a person who tested positive for COVID-19?

Contact between people includes an exchange of body fluids or having spent more than 15 minutes within 1.5 meters of each other.

never within 24 hours within the last 7 days within the last 14 days

Do you live together with others?

no, alone yes, with family or few friends yes, in a group accommodation

Do you privately take care of chronically ill or frail people?

no yes

Do you work in an institution or a profession with direct contact to many people?

no yes

Do you have a fever?

no over 38° Celsius

Are you feeling more fatigued than usual?

no unsure yes

Do you have a headache?

no yes

Do you have body aches?

no yes

Do you have a runny nose?

no yes

Have you experienced a loss of smell and taste?

no yes

Do you have a sore throat?

no yes

Do you have a persistent cough?

no yes

Do you run out of breath faster than usual?

no yes

Do you have diarrhoea?

no yes

Do you have a lung disease?

no yes

Do you have a heart or cardiovascular disease?

no yes

Do you have high blood pressure?

no yes

Do you have diabetes?

no yes

Are you very overweight?

no yes

Do you have cancer?

no yes

Are you currently undergoing chemotherapy?

no yes

Are you currently taking medication to suppress the immune system (e.g. cortisone)?

no yes

Do you smoke?

no yes

How old are you?

ave your COVID-19 self-assessment in PDF format.