Covid questionnaire

Covid questionnaire - 
Have you had a new or continuous cough or shortness of breath? 
Have you had a temperature of 38 degrees or higher or felt shivery or hot?
Have you a new loss of sense of taste and smell?
Are you or anyone in your household self isolating?
if YES, WHY?
Have you been tested for covid-19?
If YES when and what was the result?