Table 3  Coronavirus disease 2019 (COVID-19) screening questionnaire
SARS-CoV-2: Severe acute respiratory syndrome coronavirus 2; RT-PCR: Reverse transcription-polymerase chain reaction
S.no         
1  Temperature      
2  Pulse Oximetry (Spo2)      
3  Travel History      
4  Occupation      
5  Contact with COVID positive  Patient      
6  Close proximity to COVID 19 Positive patients      
7  Symptoms  Yes/ NO  If Yes, when was the onset of symptom
a  Fever      
b  Cough      
c  Fatigue      
d  Anorexia      
e  Shortness of breath      
f  Sputum production      
g  Loss of taste and smell      
h  Sore throat      
i  Diarrhea      
j  Nasal Congestion      
8)  Previous history of COVID -19 infection      
9)  Previous SARS- COV2 RT PCR test (Date)     Result – Positive/Negative