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COVID-19 Health Monitoring Questionnaire

COVID-19 Health Monitoring Questionnaire 2026

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The document is a COVID-19 Health Monitoring Questionnaire that must be completed daily by employees, students, and visitors upon arriving on campus. It includes questions about symptoms related to COVID-19, recent close contact with infected individuals, and international travel. Based on responses, it provides specific actions for employees, students, and visitors regarding isolation and contacting health care providers if any 'yes' answers are given.

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Click ‘Get Form’ to open the COVID-19 Health Monitoring Questionnaire in our editor.
Begin by entering your name and date at the top of the form. If you are a faculty, staff, or student, include your Fairfield ID#. Visitors should provide the name of their sponsoring employee.
Fill in your cell phone number or the best contact number where you can be reached.
Proceed to the symptom check section. Indicate whether you are experiencing any listed symptoms by selecting 'Yes' or 'No'.
Answer the questions regarding close contact with an infectious individual and recent international travel by selecting 'Yes' or 'No'.
If applicable, utilize the weekly dated responses record option to track your answers for each day of the week.
Review all entries for accuracy before saving your completed questionnaire.

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (105 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What should I monitor if I have COVID?

Monitor yourself for COVID-19 symptoms taste or smell, runny nose, sore throat, headache, extreme tiredness, and nausea, vomiting or diarrhea. Watch for symptoms that are new, getting worse, or not usual for you.

When should I be concerned with my COVID symptoms?

Trouble breathing. Persistent pain or pressure in the chest. New confusion. Inability to wake or stay awake.

What precautions should you take if you have COVID-19?

When you are sick: Use precautions to prevent spread, including staying home and away from others (including people you live with who are not sick) if you have respiratory symptoms. Seek health care promptly for testing and/or treatment if you have risk factors for severe illness.

What are the prescreen questions for COVID-19?

Questions relating to COVID-19 symptoms, possible exposures and travel: Have you experienced any of the following symptoms (even if they were mild) in the past 14 days? Have you been in close contact with any person experiencing symptoms or confirmed case of COVID-19? Have you traveled the last 14 days?

What to expect on day 5 of COVID?

Day 4-5: Symptoms become more pronounced; fever, cough, and fatigue intensify. Day 6: Potential appearance of gastrointestinal symptoms like nausea or diarrhea. Day 7: Heightened symptoms which may include difficulty breathing and persistent chest pain.

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