Have you traveled outside MN or WI within the last 14 days? YesNo

Have you been in contact with anyone having Covid within the past 14 days?YesNo

Have you experienced any one of the following symptoms of Covid-19 within the past 14 days:
Feverish or a fever above 100 degrees Fahrenheit, Coughing, Shortness of Breath, Muscle Aches or Sore Throat?YesNo