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



What was the result for the COVID-19 PCR test? (eg. at a drive-through, respiratory clinic or hospital that is sent to a lab)



What was the result for the Influenza PCR test?



What was the result for the Other Illness test?



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