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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? *