Covid 19 Checklist

Date & Time
Do you have symptoms such as fever, cough, sneezing, sore throat, fatigue, sense of smell, changes in taste, and body aches?:
Do you have difficulty of breathing?:
Have you travelled outside the country in the last 30 days?:
Have you traveled to other cities in India in 15 days?:
Were you a Covid-19 positive patient in the last two weeks? or suspect in a case of covid-19 ?:
Have you visited a health care facility in the past two weeks?: