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letter
. 2020 May 19;46(5):1236–1239. doi: 10.1016/j.burns.2020.05.008

Table 1.

Screening questionnaire for COVID-19.

1. Are you suffering from any fever or acute respiratory infection (sudden onset of respiratory infection with at least one of the following symptoms: shortness of breath, cough or sore throat)?
2. Have you travelled to / resided in a foreign country within the last 14 days?
3. Have you been in close contact with a person suspected or confirmed to have the COVID-19 infection? (close contact: having cared for, lived with, of had direct contact with the respiratory secretions or body fluids)
4. Have you attended or have been in close contact with anyone who has attended gatherings or events associated with a known COVID-19 outbreak?
5. Have you been in close contact with someone who is under the Home Quarantine Order or someone suspected of COVID-19 infection in the past 14 days?