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COVID-19 Safety, Recovery and Resilience

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Health Assessment Survey

Service
Please complete this daily self-assessment survey before arriving at a City of Portland facility.

1 minute

Should I come to a City facility?

Thank you for completing this self-assessment before arriving at a City of Portland facility, to protect yourself and your community.

If you answer “yes” to any of these questions, please DO NOT come to a City of Portland facility. If you are a visitor or volunteer, call your City point of contact and let them know you will be staying home. If you are an employee, call your manager or supervisor to let them know the result of your survey and be prepared to telework if the work is able to be performed remotely. Contact should not be via email, and specific symptoms are not required to be reported.

The City is not collecting or storing personal information as a result of this survey. This tool is based on information from Multnomah County and the U.S. Centers for Disease Control and Prevention about symptoms and risks for COVID-19. It is not intended to provide medical advice, diagnose or treat a health condition. If you have specific medical concerns, please contact your healthcare provider.

Have you had any of the following symptoms in the last 24 hours? (Only if it is new or unusual for you and not from a chronic or pre-existing condition.)

  • Shortness of breath or difficulty breathing
  • Body or muscle aches (not from exercise)
  • Cough (not from allergies)
  • Chills
  • Headache
  • Sore throat
  • New loss of taste or smell
  • Diarrhea
  • Nausea/vomiting
  • Fever >100 (please measure) or feeling feverish (if unable to measure)
  • Congestion or runny nose (not from allergies)
Have you received TWO Moderna or Pfizer shots, or ONE Johnson & Johnson shot more than 14 days ago?

Do you live with anyone who has symptoms of COVID-19, is awaiting test results for COVID-19, or was diagnosed with COVID-19 in the last 14 days?

In the last 14 days, have you had close contact* with anyone who has symptoms of COVID-19, was diagnosed with or is awaiting test results for COVID-19?

*Close contact is defined as being closer than 6 feet for longer than 15 minutes

Contact

Multnomah County Public Health

phone number211

Clackamas County Public Health

phone number503-742-5300

Washington County Public Health

phone number503-846-3594

Related

COVID-19 Customer Service Hours and Operations Changes

Topics

COVID-19 Information for Employees
Novel Coronavirus COVID-19

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