Start Screening Your
Organization for COVID-19 Today


Welcome to the SAMPLE Coronavirus Screening Survey. Answer the questions below to assess your risk of exposure.

Close Contact

Close Contact

Do you live in the same household with, or have you had close contact with someone who in the past 14 days was diagnosed with COVID-19 or had a test confirming they have the virus?

You are a close contact of a COVID-19 positive person if, from 48 hours before their symptoms began, the person with COVID-19:

  • Lived or stayed overnight with you
  • Was your intimate sex partner
  • Took care of you or you took care of them
  • Stayed within 6 feet of you for more than 10 minutes while they were not wearing a face mask
  • Exposed you to direct contact with their body fluids or secretions (e.g., coughed or sneezed on you) while you were not wearing a face mask, gown, and gloves