COVID-19 Online Risk Assessment Tool

Your health is important to us. Completing the assessment form below is a simple and important first step to see if you meet the current case definition for COVID-19. If you have any other medical related concerns whatsoever, please don’t hesitate to contact your local General Practitioner (GP).

Items marked with (*) is required

Patient Identification






Clinical Criteria

During the last 14 days, have you had, or do you currently experience any of the following symptoms:

1. Dry cough? *
 

2. Shortness of breath? *
 

3. Sore throat? *
 

4. Chills and/or high fever (37.5°C or more) *
 

5. Diarrhoea and/or vomiting? *
 

6. Loss of taste and/or smell? *
 

7. Chest pain? *
 

8. Body aches and/or physical weakness? *
 

9. Headaches? *
 

Travel History

During the last 14 days, have you:

10. Travelled outside of Namibia? *
 

11. Had any contact with someone who is ill and travelled outside of Namibia? *
 

Patient Exposure

During the last 14 days, have you had any contact with someone who has:

12. Tested positive for COVID-19? *
 

13. Severe respiratory tract infection (shortness of breath, severe coughing, etc.)? *
 

COVID-19 Healthcare Facility Exposure

During the last 14 days, have you:

14. Worked in a healthcare facility where COVID-19 patients are being treated? *