Sign up to participate in project to track Corona in Israel

Sign up to participate in project to track Corona in Israel
Hebrew: http://bit.ly/coronatrackisrael
English version: https://bit.ly/2UbpqN7

Facing the virus: a daily questionnaire
This questionnaire is intended to help identify the sites of the spread of
the Corona virus in Israel. It is designed to assess whether you have
developed symptoms caused by the virus. A good estimate of the number of
people in each area who have developed symptoms will help identify the
centers of the spread and the patients faster.

Thank you if you complete the questionnaire once every day. We will ask that
the questionnaire be completed by (or for) each family member individually.
It is important that even those who feel good and have not developed any
symptoms will complete the questionnaire.

It should be emphasized that this questionnaire does not diagnose virus
infection. Also, the questionnaire is anonymous and all data will be used
solely for the purpose of monitoring the spread of the virus. We take every
measure to protect the privacy of senders and information security. Thanks!

Hebrew: http://bit.ly/coronatrackisrael
Arabic: https://bit.ly/2QjAEOt
Russian: https://bit.ly/2WejvK1
English version: https://bit.ly/2UbpqN7

Professor Eran Segal, Weizmann Institute of Science
Professor Yuval Dor, Hebrew University
Professor Benjamin Geiger, Weizmann Institute of Science

Dealing with Coronavirus: A daily questionnaire
This questionnaire was designed to locate potential geographic areas in
which the coronavirus is spreading in Israel. You will be asked about
potential symptoms of the virus. A better estimation of the number of
infected people in each area will help to identify locations in which the
number of infected people is particularly high.

Please fill out the questionnaire every day and separately for each family
member. It is important to fill out the questionnaire also in cases where
you and your family are feeling well and do not experience any symptoms.

Note that this questionnaire cannot diagnose coronavirus infection. It is
anonymous and all the data will be used solely for tracking the spread of
the virus. We are taking every measure to keep the privacy of participants.

We thank you for your participation,

Prof Eran Segal, Weizmann Institute of Science
Prof Yuval Dor, The Hebrew University of Jerusalem
Prof Benjamin Geiger, Weizmann Institute of Science

* Required
Age *

Your answer

Gender *
Male
Female

City *
Your answer
Street *
Your answer
Zip code *
Find your zipcode here: https://tinyurl.com/y5ddf8jg
Your answer
Are you experiencing any of the following symptoms? *
I feel well
Cough
Fatigue
Muscle pain
Shortness of breath
Runny nose or Nasal congestion
Diarrea
Nausea and vomiting

Have you been diagnosed with any of the following conditions: Diabetes,
Hypertension, Ischemic heart disease, Asthma, Chronic lung disease, Chronic
kidney disease *
Yes
No

I am currently: *
Not in isolation
In isolation due to a recent international travel
In isolation due to a contact with an individual who was infected with
coronavirus or an individual who recently returned from any destination
abroad

Cigarette smoking habits *
I currently smoke
I used to smoke
I have never smoked

What is your current body temperature in Celsius?
Your answer

Submit
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