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  • In the past two weeks have you experienced the following as a result of covid-19?
  • In the past seven days, have you?
  • Avoid going to a social gathering with friends, peer or coworkers (not including relatives)
  • In the past 30 days, have you been sick for more than one day with an illness that included any of the following: fever, cough, sore throat, or runny or stuffy nose?
  • Have recommendations for socially distancing caused stress for your families and loved ones?
  • If I get sick, I believe I can stay home for 14 days? 
  • If I get sick, I believe I can stay home for 7 days?
  • I believe that I am at risk of being infected with COVID-19
  • Was the test for novel coronavirus positive?
  • Avoid going to a family gathering like a birthday party or wedding or funeral
  • For this illness, were you tested for novel coronavirus (COVID-19)?
  • Employment Status
  • In the last 7 days, have you:
  • To cope with social distancing and isolation, are you doing any of the following?
  • In the past week have the following behaviors increased in your household:
  • I believe that COVID-19 is a serious disease.
  • How much information do you feel you know about COVID-19?
  • I believe I can protect others from COVID-19
  • To the best of your knowledge, which of the following can protect someone from COVID-19?
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