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In the last 6 months, have you recovered from COVID-19?

This means that you have been diagnosed with COVID-19 by a medical professional and have fully recovered.

In the last 14 days, have you regularly worn a mask inside businesses and public places?

In the last 14 days, have you maintained a safe distance (at least 6 feet) from other people who are not from your household in both indoor and outdoor spaces?

In the last 14 days, did you live with someone diagnosed with COVID-19?

In the last 14 days, did you take care of anyone outside of your home that was diagnosed with COVID-19?

In the last 14 days, have you traveled to any of following states?

If you have traveled to more than one of the states listed below, please select the state you were most recently within.