Health Survey Questions
There are three types of health surveys:
Only one type of survey can be selected per organization.
Note
If your organization requires more than one type of survey we recommend creating a zone for the additional survey type.
Each survey contains questions that are assigned a point value. After the user completes the survey, their points are totaled and compared against the thresholds that are set in Settings -> Thresholds. This will determine if the user is eligible for a HealthPass.
The survey displays to the user when the Show Survey Option button is enabled. You can find this button in Settings -> User Experience -> Health Survey Configs.
Note
Contact CLEARED4 if you need to create a custom survey.
Full Survey Questions
| Question | Point Value | |
| 1 | Have you had any temperatures over 100.4 F (38 degrees C) in the last 24 hours? | 100 |
| 2 | Are you having shortness of breath right now? | 90 |
| 3 | Are you feeling dizzy or disoriented at this time? | 90 |
| 4 | Are you experiencing any persistent chest pressure or pain? | 100 |
| 5 | Have you noticed any bluish discoloration on your lips or face in the last 24 hours? | 100 |
| 6 | Have you had an unexplained cough in the last 24 hours? | 100 |
| 7 | Have you had any shaking chills or night sweats in the last 24 hours? | 90 |
| 8 | Are you currently able to move around as you normally do? | 100 |
| 9 | Have you noticed any new skin lesions on your legs, feet, or torso in the last 24 hours? | 100 |
| 10 | Do you have an unexplained runny nose, nasal congestion, or signs of a cold? Answer "no" if you think this is related to allergies. | 50 |
| 11 | Have you had any unusual headaches in the last 24 hours? | 100 |
| 12 | Have you had any changes to your sense of smell or taste in the last 24 hours? | 100 |
| 13 | Do you have a dry or sore throat? | 90 |
| 14 | Have you had any excessive fatigue in the last 24 hours? | 100 |
| 15 | Have you had any unexplained nausea in the last 24 hours? | 100 |
| 16 | Have you had any unexplained diarrhea in the last 24 hours? | 100 |
| 17 | Have you had any severe unexplained muscle pain in the last 24 hours? | 100 |
| 18 | Have you tested positive for Covid-19 in the past 5 days? | 100 |
| 19 | In the past 5 days have you been exposed (within 6 feet of anyone with active or suspected Covid-19 infection for over 15 minutes within a 24 hour period) to someone with Covid? | 100 |
Simple Survey Questions
| Question | Point Value | |
| 1 | Have you had any fever over 100.4, difficulty breathing, unexplained cough, chest pressure of pain, difficulty moving normally, changes to smell or taste, muscle aches, runny nose, diarrhea, chills and night sweats, signs of a cold, or an unexplained feeling of being unwell in the last 24 hours? | 100 |
| 2 | Have you tested positive for Covid-19 in the past 5 days? | 100 |
| 3 | In the past 5 days have you been exposed (within 6 feet of anyone with active or suspected Covid-19 infection for over 15 minutes within a 24 hour period) to someone with Covid? | 60 |
Youth Survey Questions
| Question | Point Value | |
| 1 | Does your child have (or had in the last 5 days) any temperature over 100.0, feelings of being feverish or having chills, developed shortness of breath or trouble breathing, or developed a cough or feeling of tiredness? | 50 |
| 2 | Does your child currently have (or had in the last 5 days) any muscle pain, body aches, nausea, vomiting, or diarrhea? | 50 |
| 3 | Does your child have (or had in the last 5 days) a sore throat, headache, loss of taste or smell, nasal congestion or a runny nose? | 50 |
| 4 | In the past 5 days, has your child tested positive for Covid-19? | 100 |