Is your body temperature above 38 C/100.4F? YES NO

Do you have a severe or increased cough? YES NO

Do you have a severe sore throat? YES NO

Do you have vomiting or diarrhea? YES NO

Is there a chronic disease diabetes, hypertension, liver disease..? YES NO

Have you traveled outside the country? YES NO

Have you had contact with a person with an acute respiratory infection? YES NO

Have you visited a hospital or other health place where there is a positive case of coronavirus? YES NO

Are you a healthcare member or work in sanitary sector? YES NO