KU COVID-19 Health Assessment Form

COVID-19 Health Assessment & Protocol Guidance Form
This anonymous form can help you determine the best course of action for your unique circumstances.

Daily Health Assessment - daily prevention tool to check for symptoms
Exposure Guidance - what to do if you have possibly been exposed
Testing Guidance - where and when to test
Quarantine & Isolation - the latest health department guidelines

Last Updated on 1/11/12

Please complete the fields below to generate your personalized results.

Do you currently live in shared or congregate housing, such as a dormitory, student residence hall, sorority, or fraternity?
Quarantine and isolation guidelines differ for congregate housing residents. If you aren't sure if your residence qualifies as "congregate housing," review the CDC guidance found HERE.

Yes
No

Have you experienced any of the following symptoms (and they are not something you normally experience*)? Please select all that apply.
*These might be normal if you have: a medical condition; chronic disease; allergies; dehydration; experienced these symptoms regularly over a long period of time; or other known reasons.

Have you experienced any of the following symptoms (and they are not something you normally experience*)? Please select all that apply.
*These might be normal if you have: a medical condition; chronic disease; allergies; dehydration; experienced these symptoms regularly over a long period of time; or other known reasons.
	Select
Fever or chills	Select
Cough	Select
Shortness of breath or difficulty breathing	Select
Fatigue	Select
Muscle or body aches	Select
Headache	Select
Loss of taste or smell	Select
Sore throat	Select
Congestion or runny nose	Select
Nausea or vomiting	Select
Diarrhea	Select
NONE of the above	Select

COVID-19 Health Assessment & Protocol Guidance Form This anonymous form can help you determine the best course of action for your unique circumstances.

COVID-19 Health Assessment & Protocol Guidance Form
This anonymous form can help you determine the best course of action for your unique circumstances.