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IS Adult COVID-19 Module (DISARM) Hard Copy Questionnaire Q2/2022Confidential Information contained on this form which would permit identification of any individual or establishment will be held in
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The www.jotform.com form-templates covid-19-corona covid-19 coronavirus questionnaire form is a form used to gather information related to COVID-19 symptoms, exposure, and travel history.
Individuals who may have been exposed to COVID-19, experiencing symptoms, or have traveled to high-risk areas are required to fill out the form.
To fill out the form, individuals need to provide accurate information about their symptoms, recent travel history, and any known exposure to COVID-19.
The purpose of the form is to assess the risk of COVID-19 transmission, identify potential cases, and implement necessary health measures to prevent the spread of the virus.
Information such as symptoms experienced, travel history, exposure to COVID-19 cases, and contact details must be reported on the form.
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