A MODEL OF QUESTIONNAIRE TO TEST COVID-19 FROM CANADA AND AT HOME

FRIDAY, APRIL 3, 2020

A MODEL OF QUESTIONNAIRE TO TEST COVID-19 FROM CANADA AND AT HOME

THIS COULD BE USEFUL TO ALL NATIONS AROUND THE WORLD.
A MODEL OF QUESTIONNAIRE TO TEST COVID-19 FROM CANADA


We are a group of scientists, engineers and clinicians who have created an online screening tool to provide information on COVID-19. This app is designed to help increase awareness and flatten the curve of the spread of COVID-19 by informing Canadians and healthcare systems of relevant information. Should you have any concerns, please review our Privacy Policy and Terms of Service.
Tell us how you feel!

Your answers are collected and will be made available publicly, including through our website to help healthcare providers, researchers, and others gauge the spread of COVID-19 and inform efforts that help keep yourself, your family, and your community healthy. We will use our good faith efforts to ensure your answers are shared in an aggregated manner, such as in the form of the heat map that you can view by following the link in our navigation panel above. The following questionnaire is designed to help collect information regarding your risk factors for COVID-19 infection. The questions are based on the best available guidance from Canadian public health agencies and other stakeholders and will be updated regularly. This survey is not intended to facilitate any kind of diagnosis or self-assessment for COVID-19. If you suspect you may have COVID-19, please seek medical attention. Please review our Terms of Service and Privacy Policy carefully and if you do not agree to our Terms of Service or are not comfortable with our collection, use, and disclosure of the information you provide, do not complete this Survey (though we would appreciate if you could provide feedback to us at flattenofficial@gmail.com on how we may be able to address your concerns).
Please fill in this form even if you are experiencing no symptoms.

Question : Yes or No

Do you have a fever, chills or shakes?



Do you have a new or worsening cough?



Are you experiencing shortness of breath (difficulty breathing, breathlessness)?



Are you 60 years of age or older?

Do you have any of the following medical conditions: diabetes, heart disease, active cancer, history of stroke, asthma, COPD, dialysis, or are immunocompromised?


Have you traveled outside of Canada within the last 14 days?


Have you had close contact with someone who is coughing, has a fever, or is otherwise sick and has been outside of Canada in the last 14 days or has been diagnosed with COVID-19?


Have you been diagnosed with COVID-19?


What are the first three characters of the postal code of your current residence?

https://flatten.ca/log-your-health    

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