Flutracking
DEMO
Ministry of Health NZ

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, 12 September 2022
to
Sunday, 18 September 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 because of this illness?
 | 
From which type of medical service?
(you can select more than one)









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



  COVID-19/Influenza Test  
Did you have a COVID Rapid Antigen Test (RAT) or PCR text, or an influenza PCR test during the week ending Sunday 18 September?
 |  | 
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?



  COVID-19 Vaccination  
Have you received dose 1 of a COVID-19 vaccine?
 |  | 
  Flu Vaccination  
Have you received the Annual Flu vaccine in 2022?
 |  |