Coronavirus Infection Risk Self-Assessment Questionnaire (CIRSAQ 4.0)
Scan QR Code
Remaining
*
1.
This CIRSAQ 4.0 is based on the Prevention and Treatments of 2019 Coronavirus Disease Guideline (Fifth Version) released by the National Health Commission of China on 21 February 2020 and relevant medical papers. The results provided are for personal reference only and cannot replace the doctor's diagnosis. This tool is used anonymously and data would be used for research and teaching purposes only.
Agree
Not agree
*
2.
I am living in Wuhan now, or travelled to Wuhan in the past 2 weeks.
Yes
No
*
3.
In the past 2 weeks, I lived, studied or worked together, or had any other close contact with a person with fever and cough who came from Wuhan.
Yes
No
*
4.
My workplace, school or family has at least 2 confirmed cases.
Yes
No
*
5.
I am having a fever with body temperature higher than 37.3 ℃ (99.1℉)
Yes
No
I have not measured yet.
*
6.
Now I feel (single or multiple choices)
【Multiple】
Fatigue
Cough without sputum or with little sputum
Shortness of breath
Headache or myalgia
Nasal obstruction, rhinorrhea, sneezing
Sore throat
Diarrhea
None
*
7.
I have the following diseases (single or multiple choices)
【Multiple】
Hypertension
Lung disease
Heart disease
Diabetes
Chronic kidney dysfunction
Stroke
None
*
8.
My age is (years)
≤ 30
31-40
41-50
51-60
61-70
≥ 71
*
9.
My gender is
Man
Woman
*
10.
I am a doctor or nurse
Yes
No
Evaluation object score
(?)
A.男
B.女
loading...
Powered By
www.wjx.cn