UF CTSI Clinical Research Center Questionnaire for COVID-19 Screening

Questionnaire for COVID-19 Screening

  1. Have you been tested for COVID-19 and had a positive result? When? Were you treated? Has it been greater than 14 days since treatment?
  2. Do you currently have or had in the past 14 days any of the following symptoms?
  • Fever
  • Cough
  • Shortness of breath
  • New loss of taste or smell
  • Vomiting or diarrhea
  1. Have you been in close contact (within 6 ft.) of anyone with a positive COVID-19 test result or suspected respiratory symptoms related to COVID-19 infection within the past 14 days?
  2. Have you taken a cruise of any kind (ocean or river, international or domestic) or traveled to one of these areas with widespread or ongoing community spread of COVID-19 within the last 14 days:
  • China, Iran, United Kingdom and Ireland
  • Europe
  • New York, New Jersey, Connecticut
  • COVID-19 guidelines are fluid and change with areas of community spread, please refer to the State of Florida guidelines for up to date information at the following links: https://floridahealthcovid19.gov/travelers/


If the person answers yes to any of the above questions they will not be allowed in the CRC, their Study PI/coordinator will be notified and their study visit will need to be rescheduled.

If the person is cleared with the questionnaire, obtain their temperature Temperature must be less than 100.4°F or 38°C to proceed. If the temperature meets guidelines, inform them that they may enter CRC but they will be required to wear a mask at all times in all public and patient care areas of the CRC and must practice social distancing.

Participants are limited to one visitor/caregiver during their appointment.