Flutracking
DEMO
Hunter New England Local Health District

Surveys Surveys
Participant Account for Demo

Weekly Survey

Hello Demo, and thank you for your participation in Flutracking.

Please answer the following questions for yourself and submit.

Participant Survey
Demo
For the week of:
Monday, 17 January 2022
to
Sunday, 23 January 2022
  Symptoms  
Did you have:
Fever?
 |  | 
Cough?
 |  | 
Sore throat?
 |  | 
Runny nose?
 |  | 
Shortness of breath?
 |  | 
Any change in sense of taste or smell?
 |  | 
Headache?
 |  | 
  Absence From Duties  
Were you absent from work or normal duties due to these symptoms?
 |  | 
Which days did you have off work or interrupted from normal activities?






  Medical Attention  
Did you contact a health professional due to these symptoms?
(including from COVID test centres/drive-through)
 | 
From which type of medical service?
(you can select more than one)








If Other, please provide details:
What was the Diagnosis?




  COVID-19/Influenza/Other Illness Test  
Did you have a nose or throat swab or saliva test during the week ending Sunday 23 January? (Please include any influenza tests and/or COVID-19 tests)
 |  | 
Have you received a result yet?
 |  | 
COVID-19 Rapid Antigen Test? (eg. at home, work, school etc)



COVID-19 PCR Test? (eg. at a drive-through, respiratory clinic or hospital that is sent to a lab)



Influenza PCR Test?



Other Illness Test?



  COVID-19 Vaccination  
Have you received the 1st dose of a COVID-19 vaccine?
 |  |