COVID-19 Self-Screening Questionnaire
The purpose of this questionnaire is to allow you to self-observe your daily health prior to coming to class or work. It was developed with criteria from the Centers for Disease Control and Prevention (CDC).
Take your temperature every day before going to class or work. If your temperature is greater than 100 degrees Fahrenheit, or if you answer YES to any of the following questions, please DO NOT GO TO CLASS OR COME TO WORK.
Please answer the following questions:
- Have you been tested for COVID-19 (awaiting results)? If Yes, quarantine until your results are received.
- Have you tested POSITIVE for COVID-19? If yes, quarantine for 10 days from symptom onset and 3 days beyond resolution of fever, whichever is longer.
- Have you had prolonged contact with someone who tested positive for COVID-19? If Yes, quarantine and call your healthcare provider (employee) or the Wellness Center (student) for further instructions.
- Has a roommate been tested for COVID-19 (awaiting results)? If Yes, quarantine until results are received.
- Has a roommate been asked by a healthcare provider to isolate for potential COVID-19? If Yes, quarantine for 14 days and return to classes or work only if you don't have any symptoms.
- Have you traveled out of the country within the last 14 days? If Yes, quarantine for 14 days from your arrival in the United States. Return to classes or work if you don't have any symptoms.
- Are you experiencing or have you experienced any of the following symptoms in the past 14 days? If YES to at least one of these questions, please quarantine and call your healthcare provider (employee) or the Wellness Center (student).
- Fever or chills
- Shortness of breath or difficulty breathing
- Muscle or body aches
- New loss of taste or smell
- Sore throat
- Congestion or runny nose
- Nausea or vomiting
What to do next
Answered NO to all
Report to class or work.
Answered YES to anything
Contact your healthcare provider. Winona students can also contact the Wellness Center by calling 507-457-1492 (FIRST). A nurse practitioner and RN are on campus. The door to the Wellness Center has moved to the north end of Vlazny Hall (closest to the athletic fields). Testing for COVID-19 is being made in collaboration with Mayo Clinic. Results are available within 24-36 hours. Students will quarantine in the interim and should be in contact with the Student Success Center and their professors. Employees should contact Human Resources at 507-457-1508 and their supervisors.
Additionally, you may use either of these online self-screening tools: